Step UP Strengthening evidence for programming on unintended pregnancy


Collaborating to generate, communicate, and use policy-relevant evidence

STEP UP uses a strategic, holistic approach towards research. Each research strategy integrates a continuum of linked activities and outputs, which together contribute to STEP UP’s outcome of research uptake.

Each strategy thoughtfully engages in:

    • Evidence generation: Undertaking a coherent body of robust research to address STEP UP’s priority themes. (Click on the subtabs above to explore specific research activities)
    • Communication: Effectively sharing high-quality, policy- and programme-relevant evidence with multiple stakeholders using interactive and multi-directional processes.
    • Capacity building: Increasing the capacity of STEP UP partners and stakeholders to identify, generate, communicate, and use evidence for policy and programming.
    • Partnership: Strengthening alliances and networks to increase demand for and uptake of evidence.

The evidence gaps for reducing unmet needs for family planning and safe abortion are numerous. To identify its priority research themes, STEP UP met with key stakeholders in each focus country and globally to determine the critical evidence gaps of those engaged in policy and programming. As a result of this participatory priority-setting exercise, the following themes were identified. Research activities will reflect the specific context and needs of the countries in which they are implemented as well as contributing to the global evidence base.

STEP UP's priority research themes

    • Understanding the determinants and consequences of unintended pregnancy
    • Profiling unintended pregnancy to inform national policy and programming
    • Understanding and addressing unintended pregnancy among adolescents
    • Strengthening and integrating contraceptive services within national health systems
    • Increasing access to and use of medical abortion

Understanding the determinants and consequences of unintended pregnancy

Clearly understanding and defining the meaning and measurement of unintended pregnancy is central to designing and improving policies and programmes. Therefore, STEP UP is undertaking a series of analyses to improve policy and programming so that unintended pregnancies can be prevented or more safely managed and adverse outcomes are reduced. Highlights from STEP UP activities in this theme include:

Contraception among educated women in Accra, Ghana

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—reported modern contraceptive prevalence is lower than expected for this relatively low level of fertility. A full picture of the reasons underpinning this decline in fertility is only now beginning to emerge. STEP UP research is exploring this trend to explore this question of how educated women in Ghana are able to control their fertility.

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences

Existing research on unmet need for family planning has been primarily based on the simple measures available through DHS surveys. However, there are a range of limitations to this measurement tool that limit the accuracy and utility of this information, including limitations of direct enquiry into the motivations of non-users of family planning; lack of comparable information from users; and limited information about women’s method-specific perceptions and experience of contraceptive methods. This set of studies seeks to understand: which general and method-specific factors determine membership of current, past, and never users of contraception? Could certain additions to standard DHS questions on future fertility preferences add significant explanatory power to the likelihood of current and future contraceptive use?

Evaluating whether community health extension workers (CHEWs) in Nigeria can insert contraceptive implants to the same quality standards as nurses and midwives

As part of its Family Planning 2020 commitment, the Nigerian government is aiming for a contraceptive prevalence rate of 36% by 2018, and in 2014, approved a policy to allow community health extension workers (CHEWs), in addition to doctors, nurses, and midwives, to provide contraceptive subdermal implants. 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 study aimed to compare implant provision by CHEWs versus nurses and midwives up to 14 days post insertion.

Knowledge and provision practices of misoprostol among pharmacies in Senegal

Postpartum hemorrhage (PPH) and complications related to iunsafe abortion are direct causes of maternal death in low- and middle-income countries. In Senegal, actions to eradicate this problem have made significant advances in recent years, yet there is much left to do. In pursuit of this goal, STEP UP is focusing on understanding the knowledge and practice of misoprostol provision among pharmacy workers in Senegal. The study helped to guide knowledge and practice of misoprostol provision among pharmacy workers.

Unintended pregnancy: A conceptual framework

A unified conceptual framework for describing and explaining "unintended pregnancy," and for framing policy and programmatic responses, is being developed and validated through engagement with decision-makers and researchers and through analyses of existing data. The associated analyses stemming from this framework may stimulate and influence national and global thinking and decision-making on unintended pregnancy.

Use of contraception and unintended pregnancy: A complex relationship

Profiling unintended pregnancy to inform national policy and programming

In this section: Bangladesh Country Profile; India Country Profile; Kenya Country Profile; Senegal Country Profile; Insights into Unmet Need reports

Country profiles

Four of STEP UP's focus countries (Bangladesh, India, Kenya, Senegal) identified the lack of a comprehensive analysis of the full range of factors associated with unintended pregnancy as a major evidence gap. Through a thorough and systematic desk review, secondary analyses of available datasets, and in-depth interviews with a wide range of key stakeholders, STEP UP partners compiled "country profiles" organized around six broad themes: (1) the legal, policy, and sociocultural context for sexual and reproductive health and rights; (2) trends and equity in family planning; (3) access to and quality of family planning and postabortion/safe abortion services; (4) financing and delivery mechanisms for service delivery; (5) outcomes of unintended pregnancies; and (6) policy and programmatic recommendations for reducing unmet need and unintended pregnancy.

Some key lessons learned from the Bangladesh Country Profile:

    1. The contraceptive prevalence rate in Bangladesh has increased sevenfold in the last forty years, yet from 1993–2007, the rate of unintended pregnancy barely decreased. A key reason for this is high rates of contraceptive discontinuation and a trend away from long-acting methods to shorter-acting methods.
    2. The unmet need for family planning nationwide lies at 13.5% and is higher among young women. Contraceptive discontinuation is a significant reason for unmet need; about 36% method users discontinue use within 1 year nationwide (primarily of short-acting methods), while only 14% of discontinuers switched to another method. This suggests a need for improved FP counseling and support.
    3. Discrimination against women in education, employment, marriage, and dowry has been identified as one of the prime reproductive health issues, and often results in violence.
    4. Central designed health policies inadequately address the needs of geographically-isolated populations.
    5. Abortion is illegal in Bangladesh; however, government-supported Menstrual Regulation (MR) programs have helped to reduce unsafe abortion-related deaths. However, only fifty-seven percent of facilities that are expected to provide MR actually do so.

    Please see:

Some key lessons learned from the India Country Profile:

    1. Despite six decades of large investments in family planning programming, the contraceptive prevalence rate (CPR) remains low in the North Indian states of Bihar, Madhya Pradesh and Odisha. The technical medical and counseling skills of community health providers must be reinforced and supported to improve the reach and quality of FP counselling and increase CPR.
    2. Although abortion was made legal in 1971, sex-selective abortion was made illegal in 1994, contributing to confusion among women and providers about the legality of abortion. Unsafe abortion is accordingly high, accounting for an estimated 9 to 20 percent of all maternal deaths. To correct misconceptions and reduce the level of consequent unsafe abortions, community awareness must be raised, abortion fees must be standardised, and reporting and monitoring procedures must be simplified.
    3. In all three states, infrastructural and staff shortcomings were enormous. Efforts to address the staffing gaps—such as the ASHA and ANM programs—are hampered by poor supply chains leading to unavailability in contraceptive supplies. Public-private partnerships can assist public health systems in many of these regards, although strong replicable examples are few and bear further study.

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Some key lessons learned from the Kenya Country Profile:

    1. In Kenya sexual and reproductive health (SRH) is recognized as a key human right and several measures have been taken to ensure these rights are upheld, including provisions in the new Constitution. The SRH rights of certain populations nevertheless continue to be violated—especially those of people infected or affected by HIV/AIDS, orphans and vulnerable children, refugees and internally displaced persons, and adolescents. Policies and programs should make particular efforts to reach these groups.
    2. The SRH needs of adolescent girls are shifting. Both age at sexual initiation and age at marriage among Kenyan women increased between the survey years, but the mean difference between these ages widened, indicating an increase in premarital sexual activity and the risk of pregnancy before marriage. National and regional health departments should push the implementation of the policies and guidelines to reach youth with comprehensive SRH information and services.
    3. Access to medical abortion using Mifepristone and Misoprostol is problematic as these drugs are not widely used by either practitioners or providers nor known by the women needing these services. The Ministry of Health, and national health networks should improve awareness and access to quality post-abortion care services (including reducing financial barriers to accessing care), and improve the quality of post-abortion care in both public and private health facilities.

    Please see:

Some key lessons learned from the Senegal Country Profile:

    1. Senegal has a high fertility rate of 5 children per woman, possibly due to the early age of marriage and first pregnancy, and the low rate of contraceptive use (as of 2011, only 9.6% of women were using contraception; of those, only 8.9% used a modern method).
    2. The vast majority of women who seek family planning services do so at public facilities (85%). This may suggest that focusing policy efforts at public health programs could have a significant impact on levels of unmet need for FP.
    3. Abortion is illegal in Senegal. Because of this, little data exists as to the magnitude of existing abortion, but the Senegal Ministry of Health estimates that unsafe abortion accounts for 20% of maternal morbidity.
    4. If unmet need for family planning were met, the maternal mortality rate could be decreased by 20–30%.

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Insights into unmet need

Unintended pregnancies stem primarily from unmet need for effective contraception. Many factors may contribute to unmet need. This series of studies sought to establish the relative influence of two often-cited factors: lack of access (defined as awareness of the two most widely used contraceptive methods in the country and awareness of at least one supply source); and intention to use family planning in the future. Analyses were undertaken using DHS datasets, disaggregated by different population strata, for STEP UP's three focus countries in sub-Saharan Africa: Ghana, Kenya, and Senegal.

Some key lessons learned:

    • In Ghana, 42% percent of the women had unmet need for family planning, with significant inequality across population strata; unmet need was over 50% among women with no education, or those in the poorest quintile. Yet even among wealthier women, use of modern methods has declined and use of traditional methods is more common. (Research Report: Insights into unmet need in Ghana)
    • In Kenya, most women with unmet need were aware of the two main contraceptive methods (pills and injectables) and a supplier, but the poorest, least educated women and those living in North Eastern Province had significantly less knowledge and access. The imbalanced method mix (in which pills and injectables are used by the majority of modern-method users) leads to high rates of discontinuation with low rates of switching, due to there being few options for non-hormonal methods. (Research Report: Insights into unmet need in Kenya)
    • In Senegal, over half of women having unmet need for family planning did not intend to use FP in the future; this finding was consistent across all population strata. (Research Report: Insights into unmet need in Senegal; en français)

Understanding and addressing unintended pregnancy among the urban, adolescent poor

Some of the highest levels of unintended pregnancy globally are experienced by adolescents, both married and unmarried. Their age and marginalized social status mean that they also experience more severe adverse outcomes from an unintended pregnancy, including unsafe abortion, high-risk pregnancy, and delivery leading to morbidity and mortality, unwanted childbearing, and sustained economic and social deprivation. With rapid urbanization characterising population growth in all of STEP UP's focus countries, adolescents living in, or moving into, urban informal settlements are particularly vulnerable.

STEP UP is undertaking a series of studies that explore the lives and reproductive health needs of urban poor adolescents by examining how these vary between adolescents living in various situations, including married, unmarried, older and younger, in and out of school or employment, and those living with HIV. Evidence from these studies is being used to inform the design and testing of innovative approaches to increasing access to appropriate information and services for addressing these needs.

Prevalence of unintended pregnancy and family planning needs among married adolescent girls in urban slums of Dhaka

Key lessons learned:

    • There are high levels of unintended pregnancy among married adolescent girls in urban slums; more than half of the pregnancies (53%) were unintended. This was largely due to improper use or non-use of FP. The most common reasons were: inconsistent use, cost, lack of awareness of available methods, fear of side effects, and pressure from their spouses or families to have children. There were also high levels of method discontinuation. Counseling on FP must be improved for both girls and their spouses in order to clear some of these barriers to correct method use and to ensure appropriate timing and consistent use of FP method. The support of families and community leaders must also be marshalled to support FP services for these girls.
    • Ensuring that FP services are affordable for married adolescent girls and their spouses (for instance, through a standard demand-side financing mechanism for the very poor) is also key.
    • Targeting key groups with FP services could have a significant impact on reducing unintended pregnancy (such as those who are newly married, want to postpone their pregnancy at a later age, or want to space births or have reached their ideal family size). Spouses of the adolescent girls should also be targeted to elicit their support and participation in such programs.

Policy brief: Expanding access to family planning for married adolescent girls in the urban slums of Dhaka

Research report: Expanding access to integrated family planning intervention packages for married adolescent girls in urban slums of Dhaka, Bangladesh

Research report: Prevalence of unintended pregnancy and needs for family planning among married adolescent girls living in urban slums of Dhaka, Bangladesh

Sexual and reproductive health needs of adolescents living in urban slums in Kenya

Some key lessons learned:

    • Enabling girls' re-entry into school after pregnancy must be prioritized; existing laws must be strengthened and better enforced.
    • School health programming must be improved.
    • Poor knowledge of the menstrual cycle and fertility among both men and women.
    • Universal knowledge of HIV/AIDS: Nearly 100% of male and female adolescents across all age clusters reported that they had heard of HIV/AIDS.
    • Substantial age and gender differences in HIV testing experiences: The proportion of adolescents that has ever been tested for HIV increased with age and education. Married adolescents were more likely to have ever been tested for HIV, with females more likely to have been tested than males.
    • Early initiation of sexual activity: Sexual debut before the age of 15 was reported by 11% of males and 8% of females.
    • Disconnect between adolescents’ sexual and reproductive health attitudes and their behavior: Respondents tended to place a high value on abstinence before marriage, yet many still reported engaging in premarital sexual activity.
    • High burden of unwanted and mistimed pregnancies: Thirty-six percent of females’ most recent pregnancies were unplanned, with the burden substantially higher among certain subgroups of females.

Meeting report: Nairobi City County plan of action validation meeting

Case study: KENYA: Helping adolescent mothers remain in school through strengthened implementation of school re-entry policies

Presentation: Strengthening school health programming in Nairobi City County

Book chapter: Are school principals 'the bad guys'?: Nuancing the narrative of school re-entry policy implementation in Kenya

Research report: Expanding access to secondary school education for teenage mothers in Kenya: A baseline study report

Research report: Coping with unintended pregnancies: Narratives from adolescents in Nairobi's slums

Technical working paper: Status report on the sexual and reproductive health of adolescents living in urban slums in Kenya

Journal article: Unintended pregnancies among young women living in urban slums: Evidence from a prospective study in Nairobi City, Kenya

Journal article: Adverse life events and delinquent behavior among Kenyan adolescents: A cross-sectional study on the protective role of parental monitoring, religiosity, and self-esteem

Journal article: Unintended pregnancy and subsequence use of modern contraceptives among slum and non-slum women in Nairobi, Kenya

Expert paper: Transitions to adulthood in a high fertility context: The case of sub-Saharan Africa

Journal article: Bringing sexual and reproductive health in the urban contexts to the forefront of the development agenda: The case for prioritizing the urban poor

Journal article: Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya

Journal article: The health and wellbeing of young people in sub-Saharan Africa: An under-researched area?

Journal article: Predictors of sexual debut among young adolescents in Nairobi’s informal settlements

Journal article: Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya

Understanding the reproductive health needs of adolescents in selected slums in Ghana

    • The inadequacy of RH information provided in the school system is shown by the fact that the majority (80%) of adolescents indicated that they want more classes on RH in school. A majority of parents (97%) also indicate that the school system should provide that service. There is the need for the incorporation of comprehensive sexuality education appropriate for each educational level into schools. Teachers with specialized skills in imparting this information should be trained and appropriate curriculum methodologies and materials developed.
    • Given that almost one in five (19%) of adolescents have ever been fondled against their will and 15% have ever been physically forced to have sex, a conscious effort should be made to integrate interventions to address sexual violence into reproductive health programs. Interventions that empower the adolescent to know what coercion and signs of violence as well as where to seek services should be tested.
    • Overall, the findings from this study suggest that two-thirds (66%) of parents who did discuss sexual related issues with their wards indicated that they needed more information to have meaningful discussions. In order to enhance family-based sex education, parent-oriented programs and community workshops are therefore needed to allay fears and misconceptions surrounding adolescent SRH, to enhance parents’ SRH knowledge, and to build their capacity and skills to provide information to adolescents.

Research report: Acceptability and feasibility of introducing strengthened school-based sexual and reproductive health information and services in Accra, Ghana

Research report: Understanding the reproductive health needs of adolescents in selected slums in Ghana: A public health assessment

Evidence brief: Strengthening school-based sexual and reproductive health education and services in Accra, Ghana

Evidence brief: What are the sexual and reproductive health needs of adolescents in Ghana’s slums?

Evidence brief: Community opinion leaders speak out on adolescent sexuality: What are the issues?

Evidence brief: Are parents talking to adolescents about sexuality? Evidence from four slums in Ghana

Presentation: Unforseen allies: Adults' views about adolescent health in four Ghanaian urban slums


Strengthening and integrating contraceptive services within national health systems

As sources of supply for contraceptive information and services increase and diversify and the commercial and not-for-profit sectors play increasingly important roles in most developing countries, contraception is gradually being integrated and mainstreamed into a wider variety of health care programmes within national health systems. While such strategies appear to make good sense from both client and provider perspectives, numerous implementation and financing challenges face policymakers and programme managers striving to increase access to contraception through integration.

STEP UP is supporting a series of studies to better understand these challenges and to generate evidence that can inform efforts to strengthen health systems that seek to deliver integrated services. Some key activities and lessons learned are:

Integrating contraceptive and safe abortion services with post-rape care

    • Policies, programmes, and country experiences in sub-Saharan Africa: Based on a study on how pregnancy prevention and management services feature within post-rape care services in sub-Saharan Africa, it was observed that pregnancy management and safe abortion for survivors do not feature prominently in national sexual violence guidelines in the region, with only a few exceptions. Existing provisions for pregnancy management and abortion also tend to lack detailed guidance or country-specific information that would facilitate access to these services. Furthermore, of the eight national protocols reviewed, only three treat safe abortion as an essential element of care to be provided for rape survivors, with clear guidance on its provision.

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Integrating contraceptive services with maternal health services

    • Postpartum Family Planning in Burkina Faso. There are substantial shortfalls in the availability of quality postpartum family planning. Individual counselling and the quality of information provided are often inadequate and occasions to advise women on family planning are wasted, resulting in low uptake of contraception during routine postnatal care. Furthermore, cultural traditions and practices and high desired family size limit the demand for modern contraception, which is not well understood or acceptable to many people. Yet the study indicated that there may be a margin for the expansion of demand, and improving quality of care could play a role in taking advantage of this.

      Please see:

Integrating contraceptive services with HIV/STI services

    • Symposium on SRH-HIV service integration: In response to the programmatic and policy issues arising from the conflicting evidence concerning interactions between hormonal contraception and HIV acquisition, STEP UP convened a 2011 symposium to review and discuss the critical and emerging issues around integrating SRH and HIV/AIDS services to enable dual protection. Key recommendations included: (1) For key populations, manage the provision and correct, consistent use of condoms; (2) As one of a series of studies reporting the relationship between hormonal contraception and HIV acquisition, the Heffron et al. study must be put into context given the conflicting findings; and (3) Explore the possibility of solving complex issues surrounding counseling by using social marketing, media, and information dissemination.

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Increasing access to and use of medical abortion

Increasing access to safe and effective medical abortion services (where legal) is an essential component of comprehensive sexual and reproductive health care. It also provides an important opportunity for counselling and delivery of contraceptive services to prevent repeat abortions. Despite rapid improvements in the availability of medical abortion (MA) commodities, many women have limited access to safe procedures, even when permissive policies exist. To enable women to have access to a wider range of providers who are qualified to deliver safe and effective services, STEP UP is undertaking a series of studies to better understand the challenges to providing MA in various settings and to test interventions that will contribute to increasing the availability of MA.

Key activities and lessons learned include:

Introducing menstrual regulation with medication (MRM) in Bangladesh

Despite the availability of effective modern contraceptive methods in Bangladesh, the number of unsafe abortions rises each year, increasing risk of maternal morbidity and mortality. Menstrual regulation with medication (MRM) is an important tool for achieving non-pregnancy after a missed period. MRM is a safe, WHO-approved, non-invasive alternative to MVA. The most effective drug formulation for MRM is a Misoprostol-Mifepristone combination. However, MRM is not yet widely available in Bangladesh. By increasing access to this simple and safe MR option, women’s morbidity due to MR and unsafe abortion in Bangladesh could be greatly decreased.

STEP UP partners in Bangladesh have worked to understand the barriers to MRM access and identify possible solutions. Our projects have explored (1) why women undergo induced and/or unsafe abortions and what barriers they face to accessing legal MR, and (2) the feasibility of introducing MRM in Bangladesh as a solution, and the acceptability of providing MRM using the Mifepristone-Misoprostol drug combination in urban and rural public health facilities. Through close cooperation with the Ministry of Health and Family Welfare (MoH&FW) of the People’s Republic of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and programme expansions.

Availability, use, and quality of care of medical abortion services in Kenya

Little is known about the provision of MA services in Kenya, the acceptability of MA among service providers and clients, and the content and quality of care offered. STEP UP learned that while availability of MA services is growing and attitudes towards abortion are changing, negative attitudes and beliefs towards abortion are still prevalent among health workers, the judiciary, police, and the general public. Most pharmacies are poorly equipped to provide MA services. Further, of the clients who did seek MA services, very few were given family planning counseling, indicating a critical missed opportunity to prevent repeat abortions. STEP UP also engaged in implementing and assessing quality-improvement interventions on post-abortion contraceptive uptake in Kenya.

Global assessments of medical abortion

MA provision by doctors versus midlevel providers in the US, Nepal, South Africa, Vietnam, and India

Training midlevel providers (MLPs) to conduct surgical abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion. This paper reviews the evidence that compares the effectiveness and safety of abortion procedures administered by MLPs versus doctors. It concluded that there were no statistical differences in incomplete abortion and complications for first trimester surgical and medical abortion up to 9 weeks performed by MLPs compared with physicians, indicating that access to MA could be improved by incorporating MLPs into service provision in countries where this is not currently the case. Further studies are required to establish more precise effect estimates.

What's New

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.