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  • Fostering Change in Medical Settings: A Holistic Programming Approach to “Revitalizing” IUD Use in Kenya
    The RESPOND Project’s work in revitalizing the use of long-acting contraception is highlighted as a chapter in a recently published book. Included in Critical Issues in Reproductive Health, edited by Andrzej Kulczycki, of the University of Alabama at Birmingham, is a chapter by Dr. Roy Jacobstein, Medical Director of RESPOND, on “Fostering Change in Medical Care Settings: A Holistic Programming Approach to ‘Revitalizing’ IUD Use in Kenya.” The chapter discusses strategies to accelerate the rate, extent, and sustainability of change in medical care settings, using as a case example a two-year technical assistance project mounted by EngenderHealth to revitalize use of the intrauterine device (IUD) in Kisii District of Kenya’s Nyanza Province. The project followed a holistic model involving a package of programmatic activities addressing supply, demand, and the policy/advocacy area. IUD use rose as a result of the intervention: An average of 142 IUDs were being inserted monthly at the 13 project sites by the project’s close in 2007, up from a baseline average of 28 insertions monthly—an increase of 507%. Despite district restructuring and transfer of skilled staff, increased annual levels of IUD provision (over 300%) were sustained for 30 months after the end of the project.

    The chapter (and the entire book) are available for purchase here.


  • Fragile, Threatened, and Still Urgently Needed: Family Planning Programs in Sub-Saharan Africa
    Using the latest evidence about trends in modern contraceptive use, fertility, unmet need, urbanization, and poverty in eight key African countries: Ghana, Kenya, Malawi, Nigeria, Senegal, Tanzania, Uganda and Zambia, this commentary discusses the ongoing threats to FP programs from such factors as HIV/AIDS, health workforce inadequacy, health-sector reform, and decreased funding. The article underscores the continuing validity of the health, equity, demographic, and development rationales for increased support to organized FP programs, many of which are experiencing stagnation or falloff in performance, and also summarizes what service approaches and interventions have been found to be most efficacious in increasing access to FP services.
  • Studies in Family Planning. Volume 40, Number 2, June 2009, pages 147-154.
  • Blood, men and tears: keeping IUDs in place in Bangladesh
    The Intra-Uterine Device (IUD) is an effective method of contraception, but in Bangladesh is associated with high levels of discontinuation within the first year. This study involved data collection from a retrospective cohort of women who had an IUD inserted 12 months earlier. In the cohort, 330 women were interviewed to identify factors associated with discontinuation. Later, 20 women, of the 103 who reported discontinuing because of excessive menstrual bleeding, were interviewed again and in depth about these issues. Of 330 women who had an IUD inserted, 47.3% had discontinued use one year post-insertion. In univariate and multivariate analyses, IUD discontinuation was strongly associated with side-effects (heavier periods; abdominal pain) and spousal factors (not discussing IUD with husband pre-insertion), but not with service delivery factors. In-depth interviews with women who reported excessive blood loss as the main reason for discontinuation found a doubling of both menstrual days and blood loss after IUD insertion. In Bangladesh, women cannot pray, have sexual intercourse, perform household tasks or participate in community activities during menstruation. Thus, women with menstrual side-effects faced serious physical, social and psychological challenges that made continuation difficult. Among those who discontinued, spouses were generally unsupportive and sometimes abusive, particularly when not involved in the decision to use the IUD.
    Culture, Health & Sexuality, Volume 11, Issue 5 June 2009, pages 543 - 558
  • Vasectomy the focus of the August 2009 Issue of Urological Clinics of North America
    In the United States, vasectomies are carried out more often than any other urologic surgical procedure with approximately half a million procedures performed annually. Worldwide, however, female sterilization is approximately 7 times as common as vasectomy, even though vasectomy is less expensive and is associated with less morbidity and mortality than female sterilization. The August 2009 issue of Urological Clinics of North America focuses on vasectomy and providers the practitioner (reader) with the essential information to guide client interest in the procedure. RESPOND Project staff authored the chapter Demographics of Vasectomy— USA and International for the journal issue.
    Urological Clinics of North America. 2009; 36[3]: 295–305.
  • Fostering Change in Medical Settings: Some Considerations for Family Planning Programmes
    Much of the provision of contraceptive methods and services in family planning (FP) programmes occurs in medical settings. FP service provision depends upon the knowledge, skills, and behaviour of health care providers in these settings. Those who give technical assistance to FP programmes need to understand the nature of medical settings and the dynamics of behaviour change there, in order to increase access to quality FP services. This peer-reviewed article underscores the importance of understanding the nature of medical settings and the dynamics of behavior change within them to increase access to quality FP services.
    IPPF Medical Bulletin 2009. 43[3]: 3–4.
  • The Ghana vasectomy initiative: Facilitating client-provider communication on no-scalpel vasectomy
    Laura Subramanian, Cindi Cisek, Nicholas Kanlisi, and John M. Pile 
    This article discusses an initiative to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) in Ghana in 2003-2004 and 2007-2008. Implemented at eight facilities, the initiative included the training of physicians in NSV; training of all site staff in the provision of ‘‘male-friendly'' services, as well as health promotion activities about NSV to prospective clients. Client-provider communication was assessed via a mystery client study and knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys. The results suggest that complementary, sustained provider training in client-centered services, coupled with targeted health promotion, can lead to improved client and provider knowledge and acceptance of NSV in an African context.
    Patient Education and Counseling 81 (2010) 374-380
  • Contraceptive Security: Incomplete Without Long-Acting and Permanent Methods of Family Planning
    Jane Wickstrom and Roy Jacobstein
    This commentary reviews the importance of long-acting and permanent methods (LA/PMs) of family planning and considers why they have been neglected in national contraceptive security strategies and family planning programs. The authors also provide recommendations for broadening method choice to include LA/PMs more fully, thereby increasing the ability of women and men to achieve their reproductive intentions.
    Studies in Family Planning. Volume 42 Issue 4 2011 pp.291-298
  • Meeting the Need for Modern Contraception: Effective Solutions to a Pressing Global Challenge
    Roy Jacobstein,  Carolyn Curtis, Jeff Spieler, and Scott Radloff.
    This article reviews such important topics as the benefits of family planning, trends in modern contraceptive use, the differential effectiveness of various modern methods, unmet need for modern contraception, the purpose and function of family planning programs, barriers to contraceptive access and use, and innovative and high-impact programming practices. The latter include such issues as postpartum family planning, postabortion family planning, task sharing/task shifting, and provision of mobile outreach services. The article also includes capsule summaries of family planning provision in three countries that represent "success stories" (Ethiopia, Malawi, and Rwanda), as well as of in a situation of universal access (in the United Kingdom).
    International Journal of Gynecology and Obstetrics In press. DOI: 10.1016/j.ijgo.2013.02.005
  • Contraceptive Implants: Providing Better Choice to Meet Growing Family Planning Demand
    Roy Jacobstein and Harriet Stanley
    This commentary discusses the great potential of hormonal implants to help meet the growing demand for family planning in low-resource countries, especially given a recent marked reduction in commodity costs for this method. The authors highlight innovative service delivery approaches that have increased access to and use of implants, as well as programming pitfalls that must be avoided if implant services are to be scaled up widely and well. In particular, they advocate for the importance of taking a client-centered approach, nurturing providers, ensuring clients' access to removal services, and making implant services available via dedicated providers and mobile services.
    Global Health: Science and Practice, March 2013, vol. 1 no. 1 p. 11-17 
  • Women's Growing Desire to Limit Births in Sub-Saharan Africa: Meeting the Challenge
    Lynn M. Van Lith, Melanie Yahner, and Lynn Bakamjian 
    This article uses secondary analyses of Demographic and Health Survey data from 18 countries to examine the characteristics of women in Sub-Saharan Africa who wish to limit childbearing. They find that young women in Africa often intend to limit their future births; this finding runs counter to the common assumption that only older women have such intentions. Large numbers of women have exceeded their desired fertility but do not use family planning, citing fear of side effects and health concerns as barriers. Moreover, many women who want no more children and who use contraception use short-acting contraceptive methods rather than the more effective long-acting or permanent methods. When their analyses are restricted to married women, the authors find that demand for limiting future births nearly equals that for spacing births. They argue that family planning programs must prepare to meet the growing needs of Sub-Saharan African women who want to limit future childbearing--a long-overlooked and underserved population.
    Global Health: Science and Practice, March 2013, vol. 1 no. 1 p. 97-107
  • Progestin-only contraception: Injectables and implants
    Roy Jacobstein and Chelsea B. Polis
    Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 28, Issue 6, August 2014, Pages 795–806

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