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

New journal article: Despite the steep increase in contraceptive prevalence rate (CPR) in Bangladesh since 1975, nearly a third of pregnancies are still unintended. This literature review -- Contraceptive practices among married women of reproductive age in Bangladesh: a review of the evidence -- examined contraceptive use among married women of reproductive age in Bangladesh and found that method discontinuation and switching, method failure, and method mix may be offsetting achievements in the CPR. The article concludes that government and independent bodies must renew their commitment to implement and monitor family planning strategies as a means to ensuring adherence to and provision of the most appropriate contraceptive method for couples.

New journal article: This article, The Challenges Posed by Demographic Change in sub-Saharan Africa: A Concise Overview, presents a regional overview of some of the main challenges posed by the huge demographic change sub-Saharan Africa has undergone in the twenty-first century (and will experience going forward). According to the UN Population Division, 35 years from now the population of Africa will be around 22 percent of the global total. The way that associated challenges are faced may have high stakes both regionally and globally. This article examines challenges of pressure on health and education provision, food security and agriculture, urban living conditions, employment and livelihoods, and intra-regional migration.

New research report: In Bangladesh, early marriage and childbearing have led to an adolescent fertility rate that is among the highest in the world. This study, Expanding access to integrated family planning intervention packages for married adolescent girls in urban slums of Dhaka, Bangladesh, implemented and evaluated the efficacy of three interventions on reducing unintended pregnancy and unmet need for FP among married adolescent girls in Dhaka slums: (1) formation of a married adolescent girls’ club, (2) strengthening brac community health volunteer (Shyastha Shebika) activities on family planning counselling, and 3) involving government marriage registrars (Kazis) in FP service promotion. The girls’ clubs were strongly well-received and were effective in enhancing knowledge and support throughout the community on issues of unintended pregnancy and FP. Both the girls’ groups as well as the activities of Shyastha Shebikas were seen to significantly increase contraceptive uptake, and were mutually reinforcing of one another’s activities.

New Evidence brief: In Senegal, abortion is illegal unless the life of the mother is endangered. For the past several years there has been increasing public discussion and advocacy surrounding the question of revising this law. Yet throughout this process, the voices of women who experience unintended pregnancy following rape or incest have not been heard. This Evidence Brief -- L’expérience de femmes ayant subi une grossesse non désirée au Sénégal: Une étude qualitative -- summarizes a study that documented the experiences of some of these women as a way of adding their voices to the discussion and to offer evidence in advocacy for revision of the law.

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.