In 2021, FHI 360 committed an estimated US$85 million over five years to support the goals of Family Planning 2030 (FP2030), a global movement dedicated to advancing the rights of people everywhere to access reproductive health services safely and on their own terms. As this effort advances, together we must reflect on the question: What is the future of family planning?
Celebrating self-care month: Six ways FHI 360 is advancing the self-care agenda for sexual and reproductive healthWritten by
The full version of this post originally appeared on Medium.
Self-management. Self-testing. Self-awareness. These are three pillars of self-care interventions that can help promote the sexual and reproductive health and rights (SRHR) of women, men and youth according to new guidelines released by the World Health Organization (WHO). WHO defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider.” Self-care as part of reproductive health is not a new concept. Throughout history, people have sought to control their fertility. However, in the context of a global shortage of trained health care workers and with an estimated 214 million women in developing countries who still have an unmet need for contraception, both new and existing SRHR self-care interventions can play a critical role in helping close the gap while at the same time empowering individuals to take control of their health.
This July is self-care month, and FHI 360 is excited to join partners around the world in advancing strategies to meet the SRHR needs of women, men and youth through evidence-based self-care interventions. There are six ways that FHI 360 is helping advance the SRHR self-care agenda.
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To optimize opportunities to make groundbreaking advances in contraceptive research and development (R&D), the global health community must help connect the dots to facilitate new partnerships between groups that often work in silos. For example, there is the company in the United States that is developing a promising drug delivery platform but hasn’t yet considered applying the research to contraceptive products. There is the university scientist who has an idea for a new contraceptive product but is unsure whether similar investments are being made in the private sector. There is the small company based in the global South that wants to enter the international market but lacks experience registering its contraceptive products in sub-Saharan Africa.
World Vasectomy Day offers an opportunity to consider how vasectomy can contribute to development. This underused contraceptive method is particularly important as countries work toward achieving the Family Planning 2020 goals, which include providing an additional 120 million women and girls in the world’s 69 poorest countries with access to voluntary family planning information, services and supplies by 2020.
The number 120 million is a lot of women and girls to reach, and it raises an important question: What role do men play in achieving this target?
Robust family planning initiatives protect women’s and children’s health, help fight HIV infection, reduce abortion and give women control over when they become pregnant.1 When experts and leaders from 150 countries gathered for the 2012 London Summit on Family Planning, they recognized that providing comprehensive access to contraceptives is both beneficial and achievable. They identified metrics to measure their success.
Vasectomy programs can make a strong contribution to fulfilling the Family Planning 2020 goals while allowing men to more fully participate in family planning. Vasectomy is safe, effective and one of the least expensive contraceptive methods.2 Vasectomies are provided more quickly — and are safer— than female sterilization.3
Armamentarium. It’s a big word. It’s what we in the U.S. like to call a fifty-cent word. An armamentarium refers to the full range of resources that are available to tackle a problem, often in the arena of health care.
Today, we have an unequivocal need to expand the contraceptive armamentarium for women around the world.
In some cases, this means expanding access to existing, underutilized family planning methods. In too many settings, women do not have adequate access to a full range of options, including long-acting and permanent contraceptive methods. Barriers to access include frequent stock-outs of commodities; a lack of adequate health care facilities or trained staff to administer contraceptives, especially in rural areas; prohibitively expensive client fees; a lack of comprehensive, accurate information for clients; a provider bias against the provision of long-acting methods to some women; and opposition from family members or community institutions.
This week, over 3,000 program implementers, health care providers, researchers, faith-based leaders, donors and policymakers gather in Addis Ababa, Ethiopia for the third International Conference on Family Planning. The theme of the week-long event is “Full Access, Full Choice.” The organizers explain that this is more than just a conference; it is part of a movement to garner commitments globally to implement evidence-based solutions targeting the persistent barriers to access that women and men face every day.
In addition to identifying effective service delivery and policy approaches to increase access to existing methods, we must also take advantage of this moment in Addis to make a long-term commitment to expand the contraceptive armamentarium to include new, innovative methods. The basket of family planning methods available has remained largely unchanged for several decades. There are gaps in the method mix that, if filled, could result not only in increased uptake of contraceptives by women, but also in improved continuation rates by better meeting individuals’ needs and desires.
Albertine,* a 34-year-old mother of five, was determined to get a long-acting family planning method. Because she lives in a remote part of Benin, a country of around 9 million in West Africa, she needed to travel many kilometers in the hot sun with her youngest child on her back to reach a health facility that provides contraceptives. Although she lives in an area where less than 1 percent of women use a modern family planning method, a community health worker had counseled and referred her to the health facility using a mobile phone-based tool (a service provided through the PRISE-C project, which is supported by University Research Co., LLC’s Center for Human Services and funded by the U.S. Agency for International Development).
Once she reached the health facility, Albertine insisted on getting what she called “the five-year method,” the two-rod Jadelle implant that is effective for five years of continuous use. She waited until the late afternoon — when the day’s immunization services were complete — before the midwife could see her. In a scene not uncommon in rural settings, Albertine lay across a small exam table and nursed her son on her right side while the midwife swabbed her left arm, injected the anesthesia, positioned the trocar and inserted the rods one by one. When the insertion was complete, Albertine smiled, took her implant card, and said she would be back in five years for another one!
2013 marks the 30th anniversary of the initial approval of Norplant®, the first long-lasting, reversible contraceptive implant. An innovation in contraception, the Norplant system consisted of six rods implanted in a woman’s upper arm that provided up to five years of pregnancy prevention – offering women the same discrete, highly effective, long-term, and reversible contraception offered by the IUD, without the need for a pelvic examination.
Inserting and removing six rods proved cumbersome, however, so Norplant never gained much traction globally. In the 30 years since its introduction, contraceptive implant technology has continued to evolve. Norplant’s successor, Jadelle offers the same level of pregnancy prevention but only entails two silicone rods.
Excitingly, Jadelle has played a pivotal role in bringing implants to the developing world after being approved by the (US) FDA in 2002. In 2006, another implant came onto the market. Implanon offers three years of pregnancy prevention in a single rod implant. Like Jadelle, Implanon has made an impact in the developing world. Because its delivery system is uniquely “preloaded”, health extension workers in developing countries are able to easily insert the implants.