Step UP Strengthening evidence for programming on unintended pregnancy

STRENGTHENING EVIDENCE FOR PROGRAMMING ON UNINTENDED PREGNANCY

Establishing networks, cultivating partnerships

Partnerships and networking are integral to achieving STEP UP’s desired outcomes of reaching broader audiences with evidence and for facilitating institutionalization and scaling up of interventions. STEP UP undertakes several collaborative and networking activities with key partners, and continually forms new partnerships with organizations and networks:

    • STEP UP staff participates as resource persons in several expert group meetings with WHO’s Department of Reproductive Health and Research (RHR) and participate in WHO/RHR’s Research Project Review Panel.
    • STEP UP actively participates in FIGO’s “Prevention of Unsafe Abortion” initiative through technical assistance to support the design and implementation of country action plans in Kenya and Ghana.
    • LSHTM, PC and the Guttmacher Institute implement the DFID-funded 'EVA-PMDUP' consortium to evaluate the DFID-supported "Prevention of Maternal Deaths from Unwanted Pregnancy" (PMDUP) programme in India, Malawi, Pakistan and Zambia.
    • STEP UP has a close relationship with the Reproductive Health Supplies Coalition, with staff actively participating in its Market Development Approaches Working Group and Advocacy & Accountability Working Group, as well as the Caucus on New and Underused RH technologies and the newly-formed Forum SECONAF (La Sécurité Contraceptive en Afrique Francophone).

 

Sharing the evidence

In order to make partnership development and the networking process more meaningful and fruitful, STEP UP also has a strong focus on the communication of research evidence. This communication process is designed to ensure that research products are freely accessible through public domain channels, that key decision-makers and other stakeholders are reached through active engagement processes, and that STEP UP evidence is cited in published papers and reports so that it productively informs and progresses the fields of research with which it engages. STEP UP seeks to ensure that its reports, articles, presentations, and data sets are widely available to researchers, policymakers, and programme staff worldwide.

 

2017 Family Planning Summit

Bridging the gap to FP2020: Evidence to accelerate progress towards meeting the need for family planning

The year 2017 marked the halfway point from the initiation of the FP2020 movement to 2020, the time by which our goal is for 120 million more women and girls to use contraceptives. It is essential that now more than ever, momentum is continued towards this goal. But in order that this positive momentum can bridge the gap to FP2020, we must not only implement innovative solutions, but also continually reevaluate our progress to identify lessons learned and to plug evidence gaps in the research agenda.

To coincide with the 2017 Family Planning Summit, the London School of Hygiene & Tropical Medicine, Population Council, and Marie Stopes International held a research symposium that aimed to further this goal. The symposium shared the latest evidence on unmet need for family planning, reviewed evidenced-informed programming for addressing unmet need for family planning, and discussed a research agenda aligned to the global architecture for family planning.

The symposium was held in collaboration with the DFID-funded Research Programme consortium Strengthening Evidence for Programming for Unintended Pregnancy (STEP UP) and the Maternal Healthcare Markets Evaluation Team (MET). The full summary report of the meeting can be viewed here, and the event programme can be viewed here.

Seven evidence briefs were prepared for the FP Summit, based on evidence from STEP UP and developed in partnership with DFID and WHO. The briefs highlight evidence and provide research and programme considerations for improving access to family planning, and cover the following global themes:


Over 140 researchers and stakeholders attended the symposium, including a range of academics, implementers, donors, governments, and civil society representatives. Partnerships were strengthened between London School’s MET team, the Guttmacher Institute, and the research programme consortiums RinGs and ReBUILD. The gathering and application of evidence by these entities is fortified by these partnerships, bringing us ever closer to FP2020’s goals.

The symposium featured both poster and oral presentations, and opened with a panel of presenters focused on exploring the multiple and complex reasons why women have an unmet need for family planning, which go beyond access and vary greatly by multiple factors. Examples highlighted in the presentations given ranged from geography to type of contraceptive method to age group:

Presenters also shared evidence on how programmes and innovations can address unmet need:


The panel discussion, moderated by Julia Bunting of the Population Council and featuring Ian Askew of the WHO and Mary-Ann Etiebet of Merck for Mothers, focused on the key theme of the need for a focus on translating research into action, and particularly in using evidence to both inform and evaluate programmes.

Both presenters and attendees highlighted the important roles and contributions of different types of evidence, from large-scale intervention trials and nationally representative surveys to anthropological studies. The meeting also discussed the need to push for high quality evidence, that this evidence must be timely, and that we can achieve this by aiming to identify research gaps early.

 

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.