Step UP Strengthening evidence for programming on unintended pregnancy


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Systematic review: In low- and middle-income countries (LMICs), pharmacies and drug shops are often the preferred source of health care due to their privacy, anonymity, and convenience – particularly for women seeking services for medical abortion with medication. In light of this, this systematic review of medical abortion provision by pharmacies and drug sellers in LMICs was undertaken to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion in LMICs, and 2) interventions to improve quality of provision.

Journal article: Integration of family planning counselling and method provision into safe abortion services is a key component of quality abortion care, yet numerous barriers to women’s use of post-abortion family planning (PAFP) exist. This study investigated the impact on PAFP uptake of a quality management intervention for providers in private clinics that are part of Marie Stopes Kenya social franchise network. Findings suggested that the intervention both improved quality of counseling as well as increased same-day uptake of contraceptive methods.

Policy brief: STEP UP hosted a dissemination event for stakeholders in Dhaka, Bangladesh, to share evidence gained from testing three innovative strategies aiming to support the unmet family planning needs of married adolescent girls. This policy brief, Expanding Access to Family Planning for Married Adolescent Girls in the Urban Slums of Dhaka, shares some of the key research insights and policy recommendations that were discussed.

Journal article: Although nurses, midwives, and doctors currently provide contraceptive implant services to women in Nigeria, There is a lack of rigorous evidence on the safety of long-acting reversible contraceptive provision, such as implants, among lower cadres of health providers. This journal article discusses a study supported by STEP UP that aimed to compare safety, quality, and acceptability of implants provided by Community Health Extension Workers (CHEWs) to that of nurses and midwives.

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.

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.