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 Research Uptake Case Study: STEP UP is proud to release a new Research Uptake Case Study: Bangladesh: Using strong evidence and strategic collaboration to increase access to menstrual regulation with medication. The case study highlights successful research uptake resulting from STEP UP’s collaboration on increasing women’s access to MRM in Bangladesh, including approval of MRM service introduction into the national family planning program and plans for STEP UP assistance in the scale up of MRM to nearly 4,000 health facilities.

Journal Article: Estimates of the potential impacts of contraceptive use on averting unintended pregnancies, total and unsafe abortions, maternal deaths, and newborn, infant, and child deaths are critically important for policy makers, donors, and advocates investing in family planning programmes. There are five mathematical models that estimate the impact of family planning on health outcomes, but each modeling approach was designed for different purposes, and consequently do not produce comparable estimates for the same outcome indicators. This article, Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health explores a collective harmonization process undertaken to address this. The models now produce more similar estimates (although they retain some minimal differences) and may assist in planning, resource allocation, and evaluation, and offer a more unified voice for quantifying the benefits of family planning.

Dissemination event in Nigeria: STEP UP findings from a study evaluating whether community health extension workers (CHEWs) can insert contraceptive implants to the same quality standards as nurses and midwives were shared at a dissemination meeting in Abuja last month. Over 100 participants attended, including high-level state and federal representatives, CHEWs & nurses, donors, and implementing partners. The plenary session was chaired by Dr. Kayode Afolabi (Director of reproductive health, FMOH) with support from Dr. Tony Udoh (FMOH).

The session yielded insight into key aspects of implant service provision, upon which the FMOH proposed that it review and extend the accreditation period to enhance service quality. The event also prompted commitments to be made by State officials to better support trained staff retention in training facilities, and by MSI Nigeria to provide technical support to States on scaling up this task shifting. See links for Nigerian media coverage of the event in the Daily Post, Premium Times, and Vanguard.

Journal article: In 2015, the Government of Bangladesh approved the use of the mifepristone-misoptostol drug combination to be administered up to 9 weeks from a woman’s last menstrual period by trained service providers for menstrual regulation with medication (MRM). This journal article, Provision of menstrual regulation with medication among pharmacies in three municipal districts of Bangladesh: A situation analysis, explores a STEP UP study which assessed the provision of MRM in randomly selected urban pharmacies in Bangladesh. The study revealed knowledge gaps among pharmacy workers regarding recommended dosage for MRM and inconsistent practice in informing women on effectiveness, follow-up visits, possible complications and provision of post-MRM contraceptives. Pharmacy workers need additional training and a strong monitoring and regulatory system for pharmacy provision of MRM in pharmacies should be established.

Activity update: The STEP UP team investigating reasons for unmet need for family planning (with particular attention to measurement of unintended pregnancy) in Matlab, Bangladesh has completed the second round of data collection. Over 2,300 women were interviewed. Follow-ups are also being completed with women in Nairobi and Homa Bay, Kenya.

STEP UP at the Brookings Institute: STEP UP researcher Chi-Chi Undie was invited to the Brookings Institution in Washington DC to participate in a panel at the Girls’ Education Research and Policy Symposium hosted by the Institute’s Center for Universal Education (CUE). CUE convenes policymakers, practitioners, and stakeholders in the girls’ education arena to discuss the most pressing issues as identified by the Echidna Global Scholars, a group of global leaders in girls’ education. Please click here to view video recording of the session in which Chi-Chi discusses STEP UP’s work with the Ministry of Education on school re-entry for girls in Kenya.