New Research Available: The RESPOND Project Study Series: Contributions to Global Knowledge

December 2012

• Using an Employer-Based Approach to Increase Support for and Provision of Long-Acting and Permanent Methods of Contraception: The India Experience (Report No. 7)
• Acceptability of Sino-Implant (II) in Bangladesh: Final Report on a Prospective Study (Report No. 8)
• Replication of the Community Mobilization for Postabortion Care (COMMPAC) Model in Naivasha District, Rift Valley Province, Kenya: An Evaluation Report (Report No. 9)  

Using an Employer-Based Approach to Increase Support for and Provision of Long-Acting and Permanent Methods of Contraception: The India Experience
Report No. 7, December 2012 (PDF, 1.95MB) 

The RESPOND Project implemented an employer-based approach in Kanpur, Uttar Pradesh, India, that sought to increase workers' awareness of and utilization of family planning (FP), particularly their use of long-acting and permanent methods of contraception (LA/PMs¹). This approach involved obtaining support from employers, identifying existing private-sector services as referral sites for employees interested in FP, increasing access to and support for FP through employers, and strengthening knowledge about FP services among employees.

Ten companies representing a variety of sectors, from waste management to manufacturing to beverage bottling, participated in the project, implemented from January 2011 to June 2012. The employers agreed to support the intervention by providing a venue for project activities and by allowing employees to attend activities during normal working hours. Key features of the RESPOND interventions included:

• Developing and distributing print materials, including posters, brochures, and self-standing poster displays that provided employees with FP information, with a focus on LA/PMs
• Orienting 27 health coordinators from the participating businesses on FP, particularly LA/PMs, and on interpersonal communication skills for discussing FP use with interested employees
• Implementing 61 health talks, which included an orientation to FP and an in-depth discussion of LA/PMs
• Staffing health desks placed in a well-trafficked area of the company with a RESPOND program officer or a trained counselor, distributing materials and answering questions about FP
• Identifying referral sites that provide high-quality FP services, including LA/PMs²
• Providing referrals to interested clients though a phone hotline and project staff

RESPOND sought to evaluate how and to what extent this approach changed employees' knowledge and attitudes about and use of FP, with a focus on LA/PMs. RESPOND collected program data throughout the project period and conducted a retrospective endline survey during May and June 2012 to determine the effect of the RESPOND messages.

The survey results suggest that the India LA/PM workplace initiatives provide a unique forum for achieving attitude and behaviour change around FP, particularly for methods that often have strongly associated negative attitudes and misperceptions. Employers' endorsement of FP, in the form of on-site activities and compensated time off, has the potential to weaken key barriers to LA/PM adoption. Attending a health talk encouraged employees to discuss FP with their spouses and to consider LA/PMs as potential methods for use in the future and provided work time to support this discussion and decision making. Further, the approach appears to have been effective in encouraging behaviour change: Many users of short-acting methods switched to more effective methods, and FP adoption among nonusers was also strong.

We invite you to download the report (PDF, 1.95MB).

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¹ LA/PMs are defined as the intrauterine device (IUD), the hormonal implant, female sterilization, and vasectomy. However, the implant was excluded from this intervention, as it is not available in India.
² RESPOND implemented a quality checklist at private facilities in Kanpur that provided LA/PM services; we referred clients to those that were found to provide quality services. We were not able to provide technical assistance to improve services in facilities providing less-than-quality services.

 Acceptability of Sino-Implant (II) in Bangladesh: Final Report on a Prospective Study
Report No. 8, December 2012 (PDF, 1.8MB) 

This report describes the results of a noncomparative prospective 12-month observational study that was conducted at 10 study sites in Bangladesh. The aim was to assess the acceptability and effectiveness of Sino-implant (II) among 595 women who had the device inserted in June and July 2011. The report presents data collected at baseline and at follow-up visits at three, six, and 12 months following insertion.

Selected Findings

• Participant Satisfaction: At baseline, women were satisfied with implant insertion and were given clear counseling on what to do and where to go if they experienced any problems. At follow-up, most study participants remained satisfied with Sino-implant (II) over the 12-month period. The majority (95% at three months, 97% at six months, and 94% at 12 months) reported that their experience with the method was "very favorable" or "somewhat favorable." When asked what they did not like about the method, the most frequently mentioned aspect was a change in menstruation, although this percentage declined from 50% at three months to 33% at six months and 12 months each. The most frequently mentioned positive aspects were the device's four-year duration of use and its ease of use  
• Safety and Efficacy: No serious adverse events or pregnancies were reported since the study began. The overall failure rate was zero during one year of use. Although three pregnancies were reported at the early stage of the study, these were due to misdiagnosis during participant assessment on the day of insertion.  
• Physical/mental health: More than half of the women (55% at three months, 63% at six months, and 67% at 12 months) reported no changes in physical or mental health that could be related to the implant use. Of the participants who reported issues, the major problems were headache, weakness, and body ache. The majority of complaints remained fairly constant, but a few changed over the course of implant use: Reports of headache decreased substantially (from 20% to 9% to 5%), while reports of vaginal discharge and back pain increased slightly at six months and then decreased by 12 months.

Recommendations
The findings from this study are intended to inform the Directorate General of Family Planning (DGFP) National Technical Committee's decision on whether to introduce Sino-implant (II) into Bangladesh's national family planning program. Below are selected recommendations developed for this purpose:

• Sino-Implant (II) should be introduced into the national family planning program, as it is safe and effective and acceptable to Bangladeshi women.
• Implant training curricula and protocols should be reviewed and revised with a focus on insertion technique and infection prevention procedures.
• Counseling protocols for side effects management should be revised and conducted according to World Health Organization (WHO) guidelines.

We invite you to download the study (PDF, 1.8MB).

Replication of the Community Mobilization for Postabortion Care (COMMPAC) Model in Naivasha District, Rift Valley Province, Kenya: An Evaluation Report  
Report No. 9, December 2012 (PDF, 1.9MB) 

Maternal health complications, including those arising from unsafe abortion and miscarriage, are a leading cause of morbidity among women in Kenya. The Rift Valley Province in particular has had the highest level of abortion-related outpatient morbidity in the country since at least 2003. These realities necessitate interventions to prevent unintended or mistimed pregnancies and to ensure access to quality care for women with postabortion complications.

In response to this need, the RESPOND Project replicated an existing intervention previously tested under the ACQUIRE Project. The intervention package, known as the Community Mobilization for Postabortion Care (COMMPAC) intervention, aimed at increasing awareness and use of postabortion care (PAC) services¹ and improving family planning, reproductive health, and maternal health outcomes. The interventions were carried out in three communities in Naivasha District, Rift Valley Province, over an 18-month period, from July 2010 to December 2011.

During this time, RESPOND worked with districts and communities to:

1. Strengthen service delivery points to provide PAC services
2. Conduct community mobilization to improve community involvement in and knowledge about the prevention and treatment of postabortion complications
3. Build community capacity to address needs related to PAC
4. Encourage involvement in community action of those most marginalized and most affected by postabortion complications

The effects of the intervention were then evaluated using a quasi-experimental research approach comparing three intervention sites and three comparison sites within Naivasha District, both at baseline and at endline.

Selected Results

• Overall, awareness about danger signs in early pregnancy was higher among women in the intervention areas than among their peers at the comparison sites.
• Women who experienced pregnancy complications in the intervention areas had an increased tendency to seek PAC services at dispensaries.
• Providers' confidence about offering PAC services such as manual vacuum aspiration increased, and providers in the intervention areas also had a more comprehensive awareness of the danger signs in the postabortion period than did their comparison-site counterparts.
• In the general population of women, knowledge about where PAC services may be obtained did not increase significantlyLearn more by accessing the full report.

Learn more by accessing the full report (PDF, 1.9MB).

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¹ Throughout the intervention, postabortion complications were referred to as "bleeding in the first half of pregnancy," given the sensitivities of talking about abortion and PAC in the Kenyan context.