Step UP Strengthening evidence for programming on unintended pregnancy

STRENGTHENING EVIDENCE FOR PROGRAMMING ON UNINTENDED PREGNANCY

Building the capacity to create, use, and demand high-quality evidence

STEP UP's capacity development strategy comprises several overlapping elements: building the capacity of STEP UP partners as a lasting legacy from participation in the RPC; building capacities of national partners (individuals and organizations) to demand and use research and to undertake research; and building capacity at the institutional level to use evidence around unintended pregnancy, by ensuring that issues related to unintended pregnancy are incorporated into and given appropriately high priority in global, regional and national planning and resource mobilisation.

Reviewing and refining the generation of evidence on the impact of FP and RH interventions

For evidence to be used effectively when preparing recommendations for best practices in reproductive health and family planning, it should be of a sufficiently high standard for decision-makers to have confidence in its validity and utility. STEP UP convened two series of consultations to address this:

In September 2103, STEP UP partners LSHTM and Population Council joined with USAID to organize a consultation that reviewed the range of research designs and methodologies that can be used to generate evidence on the impact of FP/RH interventions, and on their implementation, as well as the mechanisms and structures through which such evidence is then reviewed and translated into practice recommendations. The implications for organizing and funding evidence generation to maximise its quality and utility were discussed and a series of concrete recommendations proposed for:

    • Designing implementation research to maximise the quality of evidence generated and its utility for decision-making;
    • Synthesising and grading bodies of evidence on reproductive health and family planning;
    • Funding and research implementation structures and procedures to generate quality evidence and strong recommendations.


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STEP UP also convened a group of 16 technical experts at the Population Council office in New York, USA for a series of three consultations (September 2013, March 2014, and December 2014) on alternative approaches to measuring the impact of contraceptive use on averting unintended pregnancy, abortion, maternal, infant and child deaths. Four approaches were reviewed: Guttmacher Institute’s Adding it Up; MSI’s Impact 2; EngenderHealth’s Reality Check; and Futures Group FamPlan/LiST. The consultation concluded that there were sufficient differences between these approaches and the estimates generated that further discussions would be needed to identify the reasons for the differences and to provide guidance to decision-makers when using these approaches.

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Supporting the cultivation of strong research skills among students and researchers in STEP UP countries and focus areas

STEP UP supports the professional development of a number of research fellows and staff from several countries and through several partners. STEP UP fellows, researchers, and graduate students are supported to conduct, analyze, and disseminate their research; to attend conferences and symposia to meet other fellows and researchers and exchange knowledge; and to attend skill-building workshops (including skills in scientific writing, proposal development, quantitative data analysis, and policy analysis).

APHRC fellows: APHRC has supported two resident PhD fellows within APHRC’s African Doctoral Dissertation Research Fellowship (ADDRF) programme. Both fellows attended the ADDRF Scientific Writing Workshop on July 8–12, 2013 in Nairobi. The workshop aimed at training fellows on various aspects of scientific writing including the importance of publications to research, collaboration with other authors, and peer-review process. They also attended the ADDRF Scientific Symposium for Emerging Scholars in Health from July 15–17, 2013.


Population Council fellows:

    • Dr. Eliud Wekesa. STEP UP has leveraged PC’s Bixby Fellowship programme to recruit Dr. Wekesa of Kenya as a postdoctoral fellow, who is based in the Council’s Nairobi office and working with the STEP UP co-director on defining and measuring unintended pregnancy. Dr Wekesa is undertaking research that examines the ambivalence and ambiguity that is often expressed when women are asked to describe the intendedness of a pregnancy and the wantedness of a subsequent birth.


LSHTM fellows:

    • Marina Daniele: During 2013, Ms. Daniele collected data in Burkina Faso and prepared a dissertation which formed the basis of plans for a 2014 intervention research study to address the challenges in providing postpartum family planning services.

      Dissertation title: Postpartum family planning in Burkina Faso.

    • Onikepe Owolabi: Ms. Owolabi prepared a paper on unsafe abortion and contraceptive use after unwanted pregnancy and supported the preparation and implementation of a January 2014 workshop on defining and measuring unsafe abortion, organized jointly by LSHTM and the Alan Guttmacher Institute.

      Dissertation title: Unsafe abortion and contraceptive use after unwanted pregnancies in Zambia: Describing patterns and trends.
 

STEP UP also supports capacity building and professional development of its staff:

    • Dr. Fauzia Akhter Huda of icddr,b initiated her PhD program at Mahidol University in Thailand using data collected through the STEP UP funded study on Prevalence of unintended pregnancy and needs for family planning among married adolescent poor living in urban slums of Dhaka, Bangladesh.
    • Ms. Sabiha Chowdhuri of icddr,b completed a five-day training (22–26 September 2013), on the Implementation Research (IR) Tool Kit, organized jointly by icddr,b and the WHO Special Programme in Tropical Diseases. Ms. Chowdhuri also attended a quantitative data analysis course organized and conducted by the Technical Training unit, icddr,b, "Evening Course on Epidemiological Research Methods and Statistical Package for the Social Sciences (SPSS)," from 29 September to 10 October 2013.
    • Joyce Mumah from APHRC was awarded the IUSSP Junior Demographer award to attend the IUSSP-STEP UP seminar "Is access enough? Understanding and addressing unmet need" held in Nanyuki, Kenya from May 14–17. This award enabled Joyce to network with other participants at the meeting and to draft the final report of the meeting, under the guidance of the seminar organizers (Drs. Sarah Harbison and Iqbal Shah).

Working with partners in the STEP UP consortium to enhance skills in demanding, creating, and using research

The collaboration among STEP UP partners to build internal capacity is a long-term process that evolves each year of the RPC’s activities. Workshops and other capacity-building activities have included:

    • Training in the preparation of rigorous research protocols (which involved building experience in formulating research objectives, conceptual frameworks, outcome indicators, sampling and data collection methods, and analytical techniques);
    • Working collaboratively on evidence-gathering for studies;
    • Skills-development in engaging stakeholders at all stages of the research process;
    • Skills-development in managing multiple ethical reviews;
    • Support in drafting manuscripts for submission to peer-reviewed journals;
    • Working to enhance national policymakers’ ability to understand and interpret evidence generated through the country profile studies.

 

What's New

STEP UP extended for two years: We are pleased to announce that DFID has approved a two-year extension of the STEP UP RPC. During this period, our focal activities will include work on the measurement of unintended pregnancy, education sector responses to early and unintended pregnancy, and access to menstrual regulation and post-abortion contraceptive services. In addition, the RPC's efforts will reflect an increased emphasis on facilitating the uptake of the evidence generated by the program over the past six years.

Activity update on supporting girls’ re-entry into school after pregnancy in Kenya: Schools have a key role to play in both enabling adolescents to prevent unintended pregnancy as well as supporting their re-entry into school after giving birth. An interview with STEP UP researcher Chi-Chi Undie was recently published by Newsdeeply in which she discusses STEP UP research on adolescent pregnancy and school re-entry in Homa Bay and a related proposed bill currently being debated in parliament in Kenya, the Care and Protection of Child and Parents Bill. Chi also tackles the question of what needs to come first when seeking to improve girls’ learning achievement in areas where dropout rates are high in this blog post—Is girls’ enrolment the chicken or the egg?—on the UNESCO IIEP Learning Portal.

Activity update on task sharing for implant insertion in Nigeria: This study is investigating whether Community Health Extension Workers in Nigeria can insert contraceptive implants to the same standard as nurses and midwives. Data gathering has been completed and data cleaning is underway. Outcomes of this study are expected at the end of this spring, and will include the safety, quality, acceptability, and feasibility of this task-sharing activity. The study is a collaboration between the Ministry of Health of Nigeria and Marie Stopes International, and has also received funding from Danida, and SIFPO 2: Sustainable Networks, which is funded by the US Agency for International Development.

New book chapter: In existing literature about school re-entry processes in East Africa, school personnel often feature as obstacles to proper implementation of policies that would enable girls’ re-entry. This book chapter, "Are school principals 'the bad guys'?: Nuancing the narrative of school re-entry policy implementation in Kenya" (published in Changing Social Norms to Universalize Girls’ Education in East Africa), seeks to create a fuller perspective of the complexities of implementing school re-entry policy by presenting 'the other side of the story,' sharing the perspectives and experiences of school personnel themselves and identifying promising approaches for going forward.

New study protocol published: An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Yet despite the prevalence of unmet need, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. Existing data from demographic surveys provide limited insight on the full set of possible obstacles to contraceptive use. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.

New mini docu-drama on STEP UP intervention study on married adolescents: STEP UP partner icddr,b has released a short docu-drama, "Window of Hope," based on an integrated approach to preventing unintended pregnancy among married adolescent girls living in urban slums of Bangladesh. You can view the film here.