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Kate Holt/Jhpiego

Reproductive Health

According to the World Health Organization’s world population estimates, 214 million women in developing countries currently wish to delay or prevent pregnancy, yet do not use contraceptives. The reasons for non-use are complex, involving social, cultural, and economic barriers, fears about side effects, and lack of access to a trusted provider. Greater access to family planning (FP) will be vital to achieving global goals in maternal health and child survival.

MCSP supported FP interventions in 20 countries. In facilities and countries where the Program worked, more than 750,000 clients accepted an FP method, including during a maternal, neonatal or child health visit. Our strategic approach for FP centered on accelerating achievements toward Family Planning 2020 and preventing child and maternal death goals by preventing unintended pregnancies, particularly those associated with poorer health outcomes. This included pregnancies occurring too soon after a birth, among high-parity women, and among older or adolescent mothers.

Pregnancies in youth and adolescents, for example, are linked with more adverse outcomes for both mothers and infants, including preterm birth, low birth weight, and perinatal and neonatal mortality. Moreover, rapid repeat pregnancies are more common in adolescents, making this population a key priority for MCSP.

Program key strategies included:

  • Strengthening and scaling up postpartum FP (PPFP) and integration of FP along the maternal, newborn and child health (MNCH) continuum of care;
  • Expanding method choice — including long-acting reversible and permanent methods — in FP and PPFP settings; and
  • Reaching girls, their partners, and gatekeepers, whether they are mothers already or not, with appropriately targeted FP information and related care.

MCSP provided leadership to expand access to high-quality FP care and served as a global convening authority for documentation of best practices in FP/reproductive health programs. We advocated for and generated evidence around successful models that ensure every contact with a woman triggers a conversation about her reproductive intentions. At both health facility and community levels — in the context of care-seeking for herself or for her child — the aim was to link women to FP care whenever an unmet need was identified.

To address the global objective of closing innovation gaps, the Program worked on designing and field testing a number of innovations in relations to FP service delivery. These included:

  • Testing new ways to capture PPFP counseling and uptake data, especially in contexts where the health information system does not capture key indicators and we cannot add supplemental registers;
  • Learning around potential of hormonal intrauterine devices to contribute to improved access and use of contraception overall;
  • Designing and field testing program models for engaging first-time and young parents grounded in rigorous formative research; and
  • Designing and assessing models of integrated service delivery for FP and either immunizations services or nutrition services or both.


Key Results

  • MCSP was closely involved with donors and partners in organizing a global meeting around PPFP in Thailand in 2015. Together, we mobilized champions from 16 countries to develop action plans and engage their national FP technical working groups. Engagement with countries continued, in collaboration with the FP2020 secretariat, through a global PPFP Steering Committee. Thanks to regular follow up with country teams and the presence of MCSP in a large number of these countries, many reported strides in updating policies and guidelines to reflect the latest World Health Organization medical eligibility for contraceptive use guidelines related to using PPFP, revising national curricula, developing pools of trainers, and expanding related care in antenatal and maternity settings. MCSP continued to catalyze progress using opportunities such as the 2018 International Conference on Family Planning.
  • MCSP managed four communities of practice for: PPFP; Long-Activing Reversible Contraceptives and Permanent Methods (LARCs/PMs); FP-Immunization Integration; and Maternal, Infant, and Young Child Nutrition and FP Integration (MIYCN-FP). As secretariat or co-chair, MCSP hosted or organized several face-to-face consultations with partners under these various communities.
  • In Rwanda, MCSP worked with the Ministry of Health to scale-up PPFP, partnering with national stakeholders and 10 district health management teams to introduce PPFP and train providers in all 172 health facilities across 10 districts. District-level clinical mentors were identified and oriented to provide ongoing support and reinforcement to providers. During PPFP implementation within supported districts, MCSP organized several national workshops, where district and national leaders and other stakeholders discussed the benefits and challenges of PPFP and planned for expansion beyond the initial 10 MCSP-supported districts. Donors such as the UNFPA made commitments to financially support these efforts with continued technical support provided by MCSP. As of early 2018, PPFP care at the time of birth were available in 20 of Rwanda’s 30 districts.
  • MCSP supported introduction of the hormonal IUD (Levonorgestrel Intrauterine System/LNG-IUS) in the public sector in Kenya and Zambia. Previously, the high cost of existing LNG-IUS products resulted in limited availability of the method in low-resource countries. MCSP trained 45 clinical mentors in two districts in Kenya (Kisumu and Migori) and 68 mentors from four provinces in Zambia (Southern, Eastern, Luapula and Central). These mentors were then able to provide LNG-IUS to women in their communities at no cost, and were also able to train other providers using an on-site, low-dose, high frequency training approach. We also worked with the Ministry of Health in both countries to revise existing data registers to accurately collect the number of women receiving LNG-IUS, and we collected data for enhanced program monitoring and implemented studies on LNG-IUS adopters in both Kenya and Zambia. The aim of the studies was to assess the profile of women adopting the LNG-IUS and to understand the experiences of women who chose this method. Data collected revealed that a large proportion of women receiving LNG-IUS were new FP users or were switching from short-acting methods, suggesting that making hormonal IUDs available in the public sector can increase use of long-acting methods and the modern contraceptive prevalence rate. In order to ensure this work was sustainable, MCSP secured an agreement with the International Contraceptive Access Foundation to continue to provide facilities with LNG-IUS for free.
  • In Liberia, MCSP supported the provision of integrated FP, obstetric and neonatal services around the day of birth through hospital-based workshops in three MCSP-supported counties. In Malawi, MCSP supported the Ministry of Health to strengthen and systematize FP and immunization service integration at all 43 health facilities and associated outreach sites in priority districts (Ntchisi and Dowa), representing full district saturation in the two districts. Through the intervention, 306 health surveillance assistants were equipped with FP knowledge and skills, including provision of pills and injectable contraceptives (plus referrals for other FP methods). MCSP also: oriented facility staff on FP and immunization service integration both at facility and outreach; introduced communication materials and referral tracking tools; engaged community leaders to address key barriers and promote use of FP and immunization services; coordinated stakeholder engagement; and conducted quarterly integrated supervision visits. The intervention contributed to a continued increase in total contraceptive use at intervention sites, and to an increase in use of community-based FP care.
  • MCSP published several studies on the need for and provision of FP in low- and middle-income countries. Program work has been featured in journals such as Studies in Family Planning, International Perspectives on Sexual and Reproductive Health, the International Journal of Gynecology and Obstetrics, Patient Education and Counselling, Global Health Science and Practice, the Maternal and Child Health Journal, and BMJ Open.