Ensuring the Right to Quality Hormonal Implant Removal Services

Over the last decade, the use of contraceptive hormonal implants has risen worldwide,
especially in Sub-Saharan Africa and Asia. These implants are easy-to-use and reliable,
providing women and couples another option for effective, reversible contraception. By
2015, more than 10.5 million implants were distributed in resource-constrained environment
s throughout Africa and Asia, a 130% increase from three years prior in 2012.

With an increase in the use of hormonal contraceptive implants, the need to ensure
access to quality implant removal services (an integral aspect of quality services) is
evident. To expand these services, EngenderHealth is working with the Global Implant
Removals Task Force to identify best practices for implant removals, including those
related to capacity building, service provision, and research and data collection.

Implant Removals

Notably, EngenderHealth’s Expand Family Planning project (ExpandFP) has systematically implemented interventions to expand implant insertion and removal services (as well as other family planning services) in the Democratic Republic of the Congo, Tanzania, and Uganda. The project utilizes EngenderHealth’s Supply–Enabling Environment–Demand (SEED)Programming Model, engaging a holistic approach to ensure that proper supply, enabling environment, and demand components are in place to ensure access to implant insertions, removals, and other family planning services. Between January 2014 and June 2016, ExpandFP worked to engage communities, improve service capacity through training and supervision, and increase service delivery to help more than 135,000 women obtain hormonal implants. ExpandFP also facilitated access to removal services for over 4,000 women. In a three country study on client perceptions of quality and choice, a large majority of implant adopters interviewed said they were given essential information on the benefits of implants, on when and where to get the implant removed, and on their right to removal at any time.

EngenderHealth has released Contraceptive Hormonal Implant Removal Services: Experiences
from the ExpandFP Project in the Democratic Republic of the Congo, Tanzania, and Uganda
, a brief developed to assist those engaged in family planning policy and program planning, implementation, and management to understand what needs to be in place to ensure access to removal services. The brief also expands on recent increases in implant use, as well as on the ExpandFP experience described above.

It Takes a Village: Results from the Expand Family Planning Project in Tanzania

Like so many around the globe, I have spent recent weeks cheering on athletes at the 2016 Olympics in Rio de Janeiro. These athletes are real-life superheroes. Take Simone Biles, who has won the most Olympic and world championship medals ever won by an American gymnast—simply amazing. Watching the Olympics, I am inspired by and in awe of the dedication and effort needed to succeed—not just by the athlete but also all the people who helped make that success happen, including family, coaches, doctors and therapists, fans, and so many more. It is that same collective commitment by many working toward a shared goal that achieves results, no matter what the industry or field.

It is in this spirit of collective effort by a village of actors that I am very pleased to share key results from the Expand Family Planning (ExpandFP) project in Tanzania. Led by EngenderHealth, the ExpandFP project ensures clients’ full, free, and informed choice of contraceptive method while expanding the availability and use of long-acting reversible contraceptives (LARCs)—i.e., hormonal implants and intrauterine devices (IUDs). Funded by the Bill & Melinda Gates Foundation, ExpandFP is part of the global FP2020 effort to provide contraception to an additional 120 million women and girls in the world’s poorest countries by 2020. The project focused on:

  • Training health care providers and managers in family planning (FP)
  • Improving service quality and supervision
  • Ensuring clients’ rights and choice, medical follow-up care, and access to implant and IUD removal services on demand
  • Using data for decision-making, particularly for contraceptive security
  • Reaching communities with FP information; supporting community health workers and volunteers; and engaging community leaders to support FP efforts

Continue reading

Translating Global Family Planning Commitments into Local Action: The ExpandFP Project in Uganda, Tanzania, and the DRC

When I think about how far the global family planning (FP) community has come since the first International Conference on Family Planning (ICFP) in 2009, I am amazed by the progress to date. Like many of my colleagues in the field, we have seen significant momentum since FP2020 and increased resources toward improving women’s access to FP.

Equally critical to achieving the FP2020 goal of reaching 120 million new FP users, however, is how efforts are undertaken. That is why EngenderHealth, along with its partners, has taken deliberate steps toward ensuring that FP services are designed, implemented, and monitored in a way that protects women’s rights and puts their needs, desires, and preferences at the center.
Continue reading

Marie Stopes International and EngenderHealth lead endeavor to expand contraceptive choice

by Sara Malakoff, Senior Program Associate, EngenderHealth

Female sterilization is the world’s most popular contraceptive method with more than 220 million users. Sterilization is convenient for women who desire to limit childbearing, as it requires no further visits to a health care provider. In addition, it does not have the side effects that contribute to the discontinuation of user dependent methods, such as hormonal contraception. However, access to both male and female sterilization varies significantly geographically, is limited in many parts of the world (particularly in rural areas), and has not increased at a pace comparable to that of the unmet need to limit childbearing.

In an attempt to address issues of full contraceptive choice and to ensure the availability of and access to a wide range of contraceptives, including permanent methods, Marie Stopes International (MSI) and EngenderHealth under the auspices of the Support for International Family Planning Organizations (SIFPO) project funded by USAID, convened a two-day technical symposium in Nairobi in March 2014 entitled Provision of Permanent Methods of Contraception in Low-Resource Settings. A dynamic group of over 40 participants from 27 organizations and 13 countries attended the event.

Continue reading

When Everything Must Go Right So Nothing Goes Wrong

By Pamela Barnes, President & CEO, EngenderHealth

In global health, nobody has an easy job, but ensuring voluntary and safe permanent contraception is among the toughest. Everything has to go right so that nothing goes wrong.

The latest disturbing news coming from Chhattisgarh, India, reminds us that despite being 20 years post-ICPD, we global health professionals have more to do to ensure reproductive rights, choice, and quality of care. And as the story goes—as it has too many times before—the devastating consequences are borne by mostly poor, rural women. It’s unconscionable.

Although the Chhattisgarh situation is under investigation by the Government of India, we know that quality of care was compromised at all levels. This includes the conditions under which the surgical sterilizations were performed, the high number of surgeries in a given period, the questionable quality of the medications, the implicit targets set by local authorities, and financial incentives. In many ways, there isn’t a simple answer to what happened–there were a series of systemic, programmatic and clinical failures. Many organizations, including EngenderHealth, have called for a greater need to ensure and protect human rights, reproductive rights and clients’ rights; and to address informed and voluntary decision making, counseling, client safety and service quality.

But how does this translate into action? What must go right so that nothing goes wrong?

EngenderHealth’s commitment to getting everything right, beginning with our work in voluntary permanent methods decades ago, has led to the development of standards used throughout the field for informed consent, clinical safety, infection prevention, and other aspects of quality service delivery. These have also been applied to broader family planning and reproductive health issues. What we’ve learned is that investments must take place at all levels – beginning with a fundamental recognition that individuals have a basic right to full and appropriate information about their reproductive health choices and that they are able to make decisions without coercion, pressure, or inducements. For EngenderHealth, it’s about achieving a vision of client-centered care and all that is meant by this term.

For example, in India it would mean expanding the contraceptive method mix in the public sector, ensuring quality, and working to advocate for a focus to be on client’s choices rather than achieving targets. Right now, it’s mostly sterilization services, intrauterine devices (IUDs), condoms and pills—a situation which limits choice for women and others, including unmarried adolescents. We also see a greater need for training so that service providers are equipped with skills to provide voluntary, safe and quality services and can monitor quality, rights and choice for continuous quality improvement. These are examples of the kinds of concrete actions that must be undertaken as part of a broader comprehensive strategy rooted in a rights-based approach.

The incident in Chhattisgarh is a sobering reminder of what can happen when family planning services are not designed, implemented, or monitored in a way that protects and fulfills individual’s human rights. We urge the Ministry of Health and state governments to take decisive action to develop practical approaches for infusing a rights-based approach, with quality of care as one of the top priorities and with women’s needs, desires, and preferences at the center. To do otherwise would simply maintain the status quo.

—–

EngenderHealth and its partners have developed two new publications to assist diverse audiences, including donors, policymakers, program planners and managers, service providers, rights advocates, and community members, in their efforts to achieve rights-based family planning programs.

The first publication is the Voluntary Rights-based Family Planning Conceptual Framework User’s Guide, a practical resource to help stakeholders design, implement, and monitor family planning programs that respect, protect, and fulfill human rights. Coauthored with the Futures Group, with support from the Bill & Melinda Gates Foundation, the guide is a companion to the recent publication of Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework, which took long-standing family planning concepts, such as quality of care, voluntarism, and service access and linked them with human rights principles, such as empowerment, equity, nondiscrimination, and accountability. The Framework provides a holistic vision of what a rights-based family planning program looks like; the User’s Guide provides a pathway to applying the framework in actual practice.

EngenderHealth also developed Checkpoints for Choice: An Orientation and Resource Package, which takes a closer look at the concept of voluntarism—one component of a rights-based approach—and helps stakeholders understand the clients’ experience and their ability to make full, free, and informed choices about family planning. The tool, developed with support from the William and Flora Hewlett Foundation and the United States Agency for International Development, consists of a detailed plan with all support materials for a one-day workshop to enable family planning program planners and managers to strengthen the focus of family planning programs on clients’ ability to make full, free, and informed contraceptive choices in the context of a rights-based program. In addition to the workshop guidance and materials, the package includes links to recommended references, tools, and additional reading.

Missing Links: Sexual and Reproductive Health and Rights in the Post-2015 Global Development Agenda

On July 17, Katja Iversen, CEO of Women Deliver, published “Working Hard to Get the World We Want: Sexual and Reproductive Health and Rights After 2015” on The Huffington Post’s Global Motherhood blog. In this post, Iversen reports on the work of the Open Working Group (OWG) for Sustainable Development Goals, which is comprised of representatives from 70 countries and tasked with the creation of a new global framework for development that they are set to present to the United Nations Secretary-General Ban Ki-moon by the end of July. The influence of this report on the future of international development, sustainability, and human rights cannot be overstated.

The goals and targets it proposes—and the issues explicitly addressed—will be of utmost importance in the shaping of the post-2015 development agenda. Due to conservative push-back, Iversen decries, the current report language fails to include sexual and reproductive health and rights (SRHR), as well as the health of young people despite the fact that “the majority of governments have identified [SRHR] as a priority to get the world on a sustainable path.”

The blog post discusses the vital role that voluntary family planning and ensuring rights and contraceptive choices for women and girls play in ensuring equal opportunity, economic growth, and the development and maintenance of healthy populations. Iversen urges readers to take action and suggests ways to become involved in supporting the push for inclusion of SRHR in the forthcoming global development framework. Read this important post and join EngenderHealth, Women Deliver, and other organizations and individuals in the effort to make SRHR a priority in the post-2015 global development agenda and a reality for all.

Getting Real on Rights: Experience from Two Country Consultations on Applying a Rights-Based Approach to Family Planning Programming

Guest post by Shannon Harris

Given the many challenges that countries face in providing family planning (FP) services, how can a client-centered, rights-based approach to programming help governments meet their obligations to respect, protect, and fulfill clients’ rights to meet their reproductive needs and desires? This question framed two recent country consultations in India and Kenya to explore the feasibility and desirability of applying the voluntary, rights-based FP (VRBFP) conceptual framework. Were country-level FP stakeholders—program managers, policymakers, and providers—even interested in such an approach?

With funding from the Bill & Melinda Gates Foundation, the Futures Group and EngenderHealth partnered with the Population Foundation of India and the National Council for Population and Development in Kenya to host national and regional stakeholder consultations, as well as conduct FP site visits to explore these questions. Despite diverse cultural, policy and program environments, stakeholders in both countries expressed tremendous interest in using a rights-based approach. Stakeholders found the program vision described in the VRBFP framework appealing and relevant to their programs because of its emphasis on the individuals and communities served by the FP program, while simultaneously acknowledging the importance of the policy environment and supply-side factors.

Photo by H. Connor/EngenderHealth

Members of the Futures Group/EngenderHealth rights framework team visit a community motivator in India’s Bihar State to identify the realities and challenges related to protecting and fulfilling human rights in FP at the community level—specifically to identify the conditions and practices that either uphold or violate human rights. (Photo by H. Connor/EngenderHealth)

Continue reading

Hot Topic: Rights and Choice at the International Conference on Family Planning

From November 12–15, an estimated 4,000 government officials, policymakers, program managers, researchers, academics, and youth advocates will gather in Addis Ababa, Ethiopia for the 3rd Annual International Conference on Family Planning (ICFP).

The theme of this year’s conference—cohosted by The Bill and Melinda Gates Institute for Population and Reproductive Health and Ethiopia’s Ministry of Health—is “Full Access, Full Choice,” echoing the Family Planning 2020 (FP2020) initiative’s call to ensure that rights and contraceptive choice are central to meeting the commitment made at the London Summit on Family Planning to reach an additional 120 million women with access to contraception by 2020.

Continue reading

Developing Country Leaders and Advocates Urge Improved Commodity Security to Ensure Rights

Ms. Anuradha Gupta, Additional Secretary of India’s Ministry of Health and Family Welfare and Mission Director of the National Rural Health Mission (NRHM)

Ms. Anuradha Gupta, Additional Secretary of India’s Ministry of Health and Family Welfare and Mission Director of the National Rural Health Mission (NRHM) / Photo credit: RHSC

Last week, the Reproductive Health Supplies Coalition (RHSC) held their 14th annual meeting in Delhi, India. The meeting, cohosted by India’s Ministry of Health and Family Welfare, convened more than 200 participants from civil society, the private sector, and governments to work collaboratively toward strengthening the core principles of commodity security—method choice, quality, and equity—to increase access to affordable, high-quality family planning (FP). Continue reading

World Contraception Day and the UN General Assembly Millennium Development Goal Review

Celebrating World Contraception Day

Today, the international community celebrates World Contraception Day. This global campaign strives to increase awareness of contraception and encourage its use to enable people to make informed decisions about their sexual and reproductive health and to prevent unplanned pregnancy and sexually transmitted infection. This year’s motto, “Your Future, Your Choice, Your Contraception,” targets young people.

Bwaila Hospital, Lilongwe, Malawi (Photo by Holly Connor/EngenderHealth

A woman enjoys her new granddaughter at Bwaila Hospital in Lilongwe, Malawi. She is there in support of her daughter, who has requested counseling from a family planning nurse on obtaining a female sterilization. (Photo by Holly Connor/EngenderHealth)

Continue reading