Kate Holt/Jhpiego

Reproductive Health

According to the World Health Organization’s world population estimates, 214 million women in developing countries currently wish to delay or prevent pregnancy, yet do not use contraceptives. The reasons for non-use are complex, involving social, cultural, and economic barriers, fears about side effects, and lack of access to a trusted provider. Greater access to family planning (FP) will be vital to achieving global goals in maternal health and child survival.

MCSP has supported FP interventions in 20 countries. In facilities and countries where the Program works, more than 665,000 clients accepted an FP method, including during a maternal, neonatal or child health visit. Our strategic approach for FP centers on accelerating achievements toward Family Planning 2020 and Ending Preventable Child and Maternal Deaths goals by preventing unintended pregnancies, particularly those associated with poorer health outcomes. This includes pregnancies occurring too soon after a birth, among high-parity women, and among older or adolescent mothers.

Pregnancies in youth and adolescents, for example, are linked with more adverse outcomes for both mothers and infants, including preterm birth, low birth weight, and perinatal and neonatal mortality. Moreover, rapid repeat pregnancies are more common in adolescents, making this population a key priority for MCSP.

Program key strategies include:

  • Strengthening and scaling up postpartum FP (PPFP) and integration of FP along the maternal, newborn and child health (MNCH) continuum of care;
  • Expanding method choice — including long-acting reversible and permanent methods — in FP and PPFP settings; and
  • Reaching girls, their partners, and gatekeepers, whether they are mothers already or not, with appropriately targeted FP information and services (and MNCH care).

MCSP provides leadership to expand access to high-quality contraceptive services and serves as a global convening authority for documentation of best practices in FP/reproductive health programs. We advocate for and generate evidence around successful models that ensure every contact with a woman triggers a conversation about her reproductive intentions. At both health facility and community levels — in the context of care-seeking for herself or for her child — the aim is to link women to contraceptive services whenever an unmet need is identified.

To address the global objective of closing innovation gaps, the Program works on designing and field testing a number of innovations in relations to FP service delivery. These include:

  • Testing new ways to capture PPFP counseling and uptake data, especially in contexts where the health information system does not capture key indicators and we cannot add supplemental registers;
  • Learning around potential of hormonal intrauterine devices to contribute to improved access and use of contraception overall;
  • Designing and field testing program models for engaging first-time, young parents grounded in rigorous formative research; and
  • Designing and assessing models of integrated service delivery for FP and either immunizations services or nutrition services or both.

To download MCSP’s reproductive health fact sheet, click here.

Key Results

  • The Program was closely involved with donors and partners in organizing a global meeting around PPFP in Thailand in 2015. Together, we mobilized champions from 16 countries to develop action plans and engage their national FP technical working groups. Thanks to regular follow up with country teams and the presence of MCSP in a large number of these countries, many are reporting strides in updating policies and guidelines to reflect the latest World Health Organization medical eligibility for contraceptive use guidelines related to postpartum use of FP, revising national curricula, developing pools of trainers, and expanding services in antenatal and maternity settings.
  • MCSP is co-convener of two working groups — for Maternal, Infant, and Young Child Nutrition and FP Integration and FP-Immunization Integration — each with about 400 members.
  • In Rwanda, the Program is working with the Ministry of Health to scale-up PPFP, partnering with national stakeholders and four district health management teams to introduce PPFP and train providers in 47 facilities. A group of district-level clinical mentors has also been prepared to support related ongoing reinforcement and improvement services. Once PPFP service delivery was rolled out in four of the 10 MCSP-supported districts, the Program collected data on counseling and uptake to present at a national workshop, where district and national leaders discussed the benefits and challenges of PPFP and planned for expansion beyond the MCSP districts. Donors, such as the UNFPA, have made commitments to financially support these efforts, while MCSP is continuing PPFP introduction in its remaining six districts.
  • MCSP recently conducted its first training on Levonorgestrel Intrauterine System (LNG-IUS) service provision in Kenya and Zambia. In Kenya, 45 service providers from two districts are now able to provide women in their communities with a new long-acting reversible contraceptive method. During the training itself, 130 women were able to receive services which will protect them against pregnancy for up to five years. In order to ensure this work is sustainable, the Program secured an agreement with the International Contraceptive Access Foundation to continue to provide facilities with LNG-IUS at no cost.
  • In Liberia, the Program is supporting the provision of integrated FP, obstetric and neonatal services around the day of birth through hospital-based workshops in three MCSP-supported counties.
  • MCSP has published several studies on the need for and provision of FP in low- and middle-income countries. Program work has been featured in journals such as Studies in Family Planning, International Perspectives on Sexual and Reproductive Health, and the International Journal of Gynecology and Obstetrics.
Maternal Child Survival Program
Maternal and Child Survival Program