Health

  • Saplings and contraceptives: Results from a population, health and environment project in Kenya

    East African countries like Kenya have made great strides in recent decades in increasing access to modern contraception, leading to marked declines in fertility rates. But disparities remain.

    The 2014 Kenya Demographic and Health Survey showed that rural women have a total fertility rate of 4.5 children per woman versus 3.1 for urban women, and the poorest women have more than twice as many children on average than the wealthiest. Meanwhile, unmet need for contraception among poor and rural Kenyan women is higher than any other groups. Clearly, innovative solutions are needed to support women and couples in poor, remote rural areas in achieving the number and timing of pregnancies they desire.

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  • Advancing a no-missed-opportunities approach through integrating family planning and immunization services

    A no-missed-opportunities approach recognizes that every service contact presents an opportunity to comprehensively address women’s and children's health needs. Credit: Chelsea Cooper, MCHIP

    A no-missed-opportunities approach recognizes that every service contact presents an opportunity to comprehensively address women’s and children’s health needs. Credit: Chelsea Cooper, MCHIP

    When Lorpu*, a mother in Liberia, brought her baby to a clinic to receive routine immunizations, she was also counseled about family planning and offered a contraceptive method. Lorpu expressed relief about having received same-day provision of both family planning and immunization services: “When I go for [my child’s] vaccine, I can also get family planning. I don’t have to leave and come back.”

    Lorpu received these integrated services as part of a pilot program in Liberia implemented by the U.S. Agency for International Development’s (USAID) predecessor flagship Maternal and Child Health Integrated Program (MCHIP) and the Liberian Ministry of Health and Social Welfare. In participating clinics, women who brought their infants for routine immunization services were provided brief messages about family planning by the vaccinator and offered a referral for same-day services. This approach, now used by MCHIP’s successor program, the flagship Maternal and Child Survival Program (MCSP), has led to substantial increases in family planning uptake, and women have expressed positive feedback about the convenience of having access to both family planning and immunization services during the same visit.

    Integrated health care delivery is critical in the year after childbirth, when there are numerous opportunities to reach women and their infants with services — including postnatal care, immunization, growth monitoring and family planning. A no-missed-opportunities approach recognizes that every service contact presents an opportunity to comprehensively address women’s and children’s health needs.

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  • Common cause: Linking menstrual hygiene management and long-acting contraception to improve youth reproductive health

    What do family planning and menstrual hygiene management (MHM) have in common? Beyond a shared purpose to improve the health and well-being of women and girls, some family planning methods can actually improve menstrual hygiene. Menstrual Hygiene Day on May 28 offers an opportunity to explore synergies between the two fields.

    In recent years, the MHM movement has focused on the critical role that good menstrual hygiene management plays in enabling women and girls to achieve their full potential. Reducing the stigma associated with menstruation and ensuring that adolescent girls and women are able to safely manage their menses can eliminate some of the barriers that prevent girls and women in many countries from participating in day-to-day activities, such as attending school.

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  • Envisioning a world in which youth are at the center of their reproductive lives

    Kelly L’EngleImagine the potential if each one of the 600 million adolescent girls in developing countries could have full control over her reproductive life. She would be able to stay in school, delay marriage, postpone pregnancy, and support herself and her community. Yet, approximately 16 million girls between the ages of 15 and 19 give birth each year and one-third of girls give birth before their 20th birthday.

    To advocate for young people’s access to safe, reliable contraceptive information and services, FHI 360 co-hosted a meeting today on youth and long-acting reversible contraceptives (LARCS). With participants including the LARC and Permanent Methods Community of Practice Secretariat, Population Services International, Marie Stopes International and Pathfinder, the meeting highlighted the range of highly effective contraception methods available and provided a platform for tackling tough questions about how to effectively promote LARCs for youth.

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  • In Ghana, a louder approach to a silent killer: Hypertension

    Hypertension is a serious public health issue, with nearly one billion people across the world currently hypertensive. And the numbers are increasing every day. In Ghana, where we are based, the number of reported new cases in outpatient public health facilities increased more than tenfold between 1988 and 2007. A recent estimate of the prevalence of hypertension in Ghana was 27.3 percent.

    If hypertension is identified early, it can be treated and managed to prevent life-threatening diseases such as stroke and heart failure.

    In the Lower Manya Krobo, a district in the eastern region of Ghana with a population of nearly 100,000, there is a growing recognition of the increasing burden of hypertension. Unpublished 2014 data from the Lower Manya Krobo District ranked the disease as the eighth leading cause of mortality in the district, accounting for 3.8 percent of all deaths. This figure underestimates the overall impact of hypertension because it has a role as a risk factor for other, potentially fatal diseases, such as cardiac diseases, congestive heart failure and cerebrovascular disease. When combined, these conditions would rank as the leading cause of death (25.4 percent) in the district.

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  • Malaria elimination and the role of partnerships

    Roll Back MalariaWe’re working toward malaria eradication. How close are we?

    Malaria eradication as a shared vision can mobilize stakeholders and much-needed financial resources. The World Health Organization estimates that 584,000 people died from malaria in 2013. So, while that big goal of eradication is important, malaria elimination, which means the end of endemic transmission, is what many countries are aspiring to in the meantime. As noted in the President’s Malaria Initiative’s World Malaria Day report for 2015, the community continues to work toward a vaccine, and we’ve had some impressive successes in reducing mortality and increasing the uptake of prevention measures. But, there is much more to be done in order to defeat malaria.

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  • The specter of segregation haunts global health

    There is no question that the greatest health achievements under the Millennium Development Goals have focused on single diseases. Arresting the spread of HIV and AIDS and malaria is perhaps the most significant development success of the new century. And vaccination, especially of measles, is one of the reasons that deaths among older children have fallen faster than deaths among infants or women during pregnancy and childbirth.

    In contrast, the lowest-performing areas across all eight MDGs — reducing infant and maternal deaths — are targets that don’t lend themselves to a single disease strategy. Just six countries have met the MDG target for reducing infant deaths, and only 15 countries have achieved the target for reducing maternal deaths.

    Could these targets have actually been achieved if we had pursued an integrated approach to advancing the health of women and children? Did our fascination with and confidence in the segregation of single-disease initiatives cost us achievement in other areas requiring more complex solutions?

    Read the remainder of the blog here.

  • The thin blue line: Increasing access to pregnancy tests in family planning programs

    What is the true value of a 10-cent (US$) pregnancy test? In many countries, women are routinely denied same-day provision of family planning methods if they arrive at the clinic on a day when they are not menstruating. When it comes to ensuring reliable access to contraception, it turns out that simple, low-cost pregnancy tests can be extremely valuable.

    Sonia, a 49-year-old woman in Rwanda, is a long-time user of Depo-Provera, the popular three-month injectable contraceptive. She explains that women who are not menstruating are often turned away for family planning services because health care providers are concerned that these women might be pregnant. Many are told to return during their next menses, leaving them at risk of unintended pregnancy in the meantime. Sonia says, “When you get there, they ask if you are having your period. When it is ‘no,’ they give you another appointment. When it is ‘yes,’ they give you cotton wool and you go somewhere discreet to put some blood [on it] and come back to show it to the provider. It is only then that the provider shows you the methods.”

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  • A unique partnership develops emerging global health researchers

    WASH_ConferenceAd_10yrbadge_blueAt FHI 360, cultivating partnerships and building capacity are high priorities that lead to lasting impact globally. Capacity development in global health has many facets. In the more than 70 countries where we work, many of our global health, population and nutrition programs and research studies include the training of public health workers and scientists. We also value partnerships in the United States that foster the development of the next generation of public health leaders.

    This year marks the 10th anniversary of the FHI 360 and University of North Carolina (UNC) Gillings School of Global Public Health Research Fellowship Program. This relationship provides graduate students from the Gillings School with the opportunity to work side by side with leading global health researchers. For the last decade, FHI 360 and UNC have built and sustained a local partnership through which yearly at least two students from the Gillings School work at FHI 360 and are mentored by our global health research experts.

    Through this program, FHI 360 has had the privilege of working with some of the brightest young minds in the growing field of global health research. Over the years, 23 fellows have worked on a wide range of topics, generated research protocols, analyzed data, written manuscripts for scientific journals and developed technical skills that are essential to global health research.

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  • Sayana® Press could mean a breakthrough in family planning

    As elsewhere in Africa, a woman in rural Malawi often must walk for miles to reach the nearest health clinic. When she finally arrives, long queues await and a preferred contraceptive, Depo-Provera®, is often unavailable. Even if the barriers of distance, long waits and stock-outs did not exist, a busy clinic would not be an ideal venue for those who seek contraception in a private setting away from the prying eyes of neighbors and acquaintances. Many women use Depo-Provera because it is effective, requires only a single injection every three months and can be used without the knowledge of a sexual partner.

    In many villages in Malawi, and other countries, an auxiliary nurse sells a wide variety of over-the-counter medicines, as well as condoms and oral contraceptives, in a small drug shop. Women in these villages wish that injectable contraceptives were as easily and discreetly available as the pills and condoms in the drug shop.

    This situation may soon change with the arrival of a new, lower-dose formula of Depo-Provera called Sayana® Press. Sayana Press provides the same three months of safe, effective pregnancy prevention as Depo-Provera but comes in an easy-to-use, pre-filled injection device designed to allow low-level health workers, and even users themselves, to inject the product. To further simplify the injection, the long needle formerly required for deep muscle injections has been replaced by a much shorter needle for a simple injection just beneath the skin.

    Several countries in Africa, such as Senegal and Uganda, are beginning to use Sayana Press in their family planning programs, especially those in which community health workers provide contraceptives. More importantly, a few countries will soon begin stocking Sayana Press in pharmacies and perhaps rural drug shops.

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