Family Planning

Pathfinder has provided community-based family planning and reproductive health services to women and men throughout the developing world for over 50 years. Partnerships with local governments and Nongovernmental Organizations (NGOs) allow Pathfinder access into
communities to provide information and services. These local organizations provide a solid, established network through which Pathfinder reaches people. Faith-Based Organizations (FBOs) are a vital extension of this network. [author’s description]


This report provides information on: the process of building relationships; partn

This report presents the findings from an assessment of the contraceptive method mix in Myanmar focusing on birth spacing, the providers of birth spacing services (public, private, NGO) and the information needs of these health pracitioners. [adapted from publisher’s summary]

To improve birth spacing services in Cambodia, the development of the communication and counselling skills of all providers is critical. A a large part of this issue focuses on these skills. [editor’s description]

Although misconceptions about family planning and cultural factors such as son preference presented some obstacles to progress, [two MSH] projects found that religion in Afghanistan is not a barrier to expanding family planning services. It was critical to engage clinicians and communities in culturally sensitive ways. Emphasizing the use of birth spacing to protect the health of mothers and children was especially effective. Activities to empower women—including a health-oriented literacy program—and increase the number of female community workers supported rapid scale-up of contraceptive use.

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use. The pregnancy, combined oral contraceptive (COC), depot-medroxyprogesterone acetate (DMPA), and intrauterine device ( IUD) checklists allow health care workers to avoid medical barriers and better provide methods of contraception.

The guides in this toolkit are intented to be used to facilitate a broad discussion of the elements and conditions that underpin the concept of informed and voluntary decision making, help users assess the status of sexual reproductive health decision making in a given program by identifying the challenges and supporting factors at the individual/community, service-deliver, and policy levels, and to help users plan strategies to strengthen supports for clients’ reproductive health decision making.

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

Nepal’s National Health Training Center (NHTC), the Family Health Division (FHD), USAID/Nepal, and JHPIEGO developed a Comprehensive Family Planning (COFP) course to provide comprehensive and effective training for family planning (FP) service providers in Nepal. Designed to increase training efficiency—by consolidating isolated courses into one complete, standardized course and by introducing competency-based, humanistic training approaches—the COFP course was intended to provide health workers with a complete range of essential FP information and skills necessary to provide quality services to clients. A number of agencies and individuals collaborated to adapt and develop these standardized training materials, and trainers were then specially prepared to deliver this course. [publisher’s description]

This primer introduces key aspects of contracting and summarizes key lessons from countries’ experiences in contracting-out. In doing so, it is intended to serve the practical needs of contracting practicioners in developing countries that are considering contracting as a way to deliver RH/FP services. Intended users include country-level decision makers, contract operation managers, and mission officers and advisers from donor agencies. [publisher’s description]

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated. Activities/tools: Sample provider self-assessment form, sources of costs, evaluation of marginal benefit.

Contraceptive security requires comprehensive and integrated approaches that go beyond the public sector. Private sector involvement is critical not only in helping respond to growing market demand but also in ensuring equity in the contraceptive market. Redirecting well-off clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. Governments and donors cannot mandate private sector expansion and roles; however, they can create favorable conditions that induce private providers to enter the FP/RH market. [author’s description]

In developing countries, postabortion care (PAC) programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. This technical brief evaluates efforts to decentralize PAC activities in Senegal and Tanzania that show PAC can be safely and successfully decentralized with services capably provided by mid-level personnel in health centers, dispensaries, and some health posts when providers are trained and supervised and equipment and supplies are available. [adap

This issue of The Family Planning Manager will help you to asses both the opportunities and the risks inherent in decentralizing your program. It will help you identify the new relationships that must exist between the central and local level managers, and the types of skills that local level managers must have in order for decentralization to have a positive impact. [author’s description]

Under the USAID AIDS, Population and Health Integrated Assistance project, JHPIEGO has been working since 1995 with the Division of Primary Health Care (DPHC), the Nursing Council of Kenya (NCK) and the Division of Nursing (DON) to pioneer the development of an integrated clinical training system used for both preservice and inservice family planning (FP) training. JHPIEGO and its partners have strengthened both inservice training and preservice education systems cost-effectively by developing a core group of trainers, tutors and preceptors. In addition, training materials, for both student and participant use, have been supplied to a limited number of clinical facilities. [publisher’s description]

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

In both Senegal and Mali, JHPIEGO used a “jumpstart” training approach that combines both basic and intermediate training to ensure that participants are not only competent but are also confident in the skills or procedures acquired during training. High caseloads are needed so that trainers can have enough practice to achieve both competency and confidence in method provision skills—insertion and removal. The Klinik Raden Saleh (KRS), in Indonesia, was selected as the jumpstart training center for the Senegalese and Malian clinical teams because of its large Norplant implants clinical caseload, extensive clinical training, programmatic and research experience, large number of master trainers and clinical coaches, and extensive use of midwives as trainers and service providers. [publisher’s description]

The 2004 Egypt Service Provision Assessment (ESPA 2004) survey was designed to collect informationon the provision of reproductive health and child health services in Egypt in order to complement the information obtained through the 2003 Egypt Interim Demographic and Health Survey. The ESPA 2004 collected information on the preparedness of health facilities in Egypt to provide high quality care to clients seeking services for family planning, maternal health, child health, and sexually transmitted infections. A representative sample of 659 clinics of all types of facilities, in both government and nongovernmental organization facilities, was assessed. The survey included, in addition to the resources of the facilities, interviews with service providers, observations of consultations between the providers and clients, and interviews with clients after they were served. The information included in this report is important for identifying areas of intervention that will help improve the quality of family planning, maternal health, and child health services provided to clients. [preface]

This issue offers an overview of the core factors contributing to the success of family planning programs. Family planning professionals around the world helped to identify these 10 crucial program elements. This report highlights program experiences, best practices, and evidence-based guidance derived from nearly six decades of experience in international family planning. [adapted from author]

Sections of the report that address HRH include “High-Performing Staff” (p. 16).

This report details the impact of Pathfinder Interational’s community-based approach to reproductive health and family planning in Ethiopia.

The goal of this paper is to describe the establishment of a self-sustaining Student Learning Center (SLC) employing humanistic anatomical models to aid in the teaching of family planning and reproductive health clinical skills to nursing students in Nepal.

JHPIEGO has been working since 1991 to support the development of a national integrated clinical training system used for both family planning/reproductive health (FP/RH) preservice education and inservice training in Turkey. In summary, this project has made substantial gains in meeting the USAID/Turkey results package from the Strategic Objective, Increased Utilization of FP/RH Services, through Intermediate Result 2, Expansion of High Quality FP/RH Services in the Public and Private Sectors, and two Sub-Results-2.1 Increased Availability of Postpartum and Postabortion FP Services and 2.3 Improved Job Performance of Health Providers, Trainers, and Administrators. It has been successful in assisting the MOH, medical institutions, and midwifery schools to establish a national, integrated training system capable of sustaining high-quality preservice education programs for interns and midwives. The inservice training system that has been established will support the MOH in their effort to expand FP/RH training to other provinces in coming years. The preservice education system will support all university-based midwifery school students by strengthening their FP/RH and maternal health skills as they progress toward their degree. [adapted from publisher]

Using the training needs projection methods in the Spectrum Policy Modeling System software module ProTrain

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts. JHPIEGO preservice assistance focused on improving FP/RH education in three medical and nine nursing schools, and the role of the training teams at the NTCs moved toward supporting the preservice education efforts.

The popularity of female sterilization often falls behind other FP methods due in partly because the method is permanent, but mostly because there is a lack of trained service providers who are competent in performing this procedure. Government hospitals and clinics are the primary service delivery points for FP services and, in fact, provide services to more than two-thirds of Kenyan women who use modern methods of contraception. There is, therefore, a strong need for appropriately trained service providers at these sites who can support the service provision system. [publisher’s description]

This report describes the implementation of birth spacing education and outreach activities for health workers in Cambodia. It includes a description of the training of health center staff responsible for the birth spacing program and commune nurses as well as the roles of the health workers in implementing the outreach in the villages. [adapted from author]

This document focuses on FP integration with HIV services, more specifically with HIV care and treatment services. It encourages supervisors or planners, service providers, and community-based personnel to consider opportunities for operationalizing client-responsive integration of FP and HIV services.

Women with HIV have much the same reasons to have children or to prevent pregnancy as everyone else, but they have important additional issues to consider. These women’s health care providers have the responsibility to help them make well-informed and well-considered choices and carry out their decisions with the least risk. With the help of this issue of Population Reports, family planning and HIV-care providers can: understand how HIV affects women’s reproductive health and childbearing decisions; learn the latest, evidence-based information to help women with HIV think through their family planning choices; and inform women with HIV who are thinking about having children of the risks of transmitting HIV to the infant and/or uninfected partner and how they can reduce these risks.

The Family Planning Manager’s Handbook is a standard text in management training courses around the world and has received wide recognition as a practical guide for managers of health and family planning programs. [publisher’s description]