The INFO Project Blog

For our Elements of Successful Family Planning Web site, we are talking to experts about what they feel the most important components of good programs are. While in Research Triangle Park, North Carolina for the Science Blogging 2008 conference, I caught up with several excellent sources of information on this topic at Family Health International world HQ, on an unremarkable strip of Highway 54. Unfortunately, INFO’s video camera was not working, so the audio recording of the conversations is what will go up on the Media Library of the Family Planning Success Web site when it launches later this month.

Here is a sneak preview of my conversation with Dr. John Stanback, Senior Research Associate for Family Health International. Dr. Stanback on Community-Based Distribution of Injectables.

In this clip, he argues in favor of providing injectable contraception without prescriptions from rural drug shops, based on his experience studying the way this works in Uganda.

CBDs [community based distributors] are typically para-medicals that have received a little bit of training; much less then a medical professional or anyone with clinical training. So far it seems that the CBDs can do just as good a job, if they are properly trained, as the nurses… If it can be made safe, it would be great opportunity to improve access.

Click here to hear from Dr. Stanback’s colleague Dr. Irina Yacobson, talking about the importance of well-trained family planning staff.

Calling all Francophone family planning providers. Vous etes la?

FHI has released a new French-language tool for decision makers to kick off community-based distribution of the injectable contraceptive DMPA. This new advocacy tool discusses best practices for successful implementation of this type of distribution, such as training, counseling, and ensuring supply.

The checklist included in the kit is based on the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use.

For FHI’s English-language toolkit on community-based distribution click here.

To see INFO’s Injectables Toolkit click here.  

Want more on injectables? See the Population Reports guide to Expanding Service for Injectables.

Calling all Francophone family planning providers. Vous etes la?

FHI has released a new French-language tool for decision makers to kick off community-based distribution of the injectable contraceptive DMPA. This new advocacy tool discusses best practices for successful implementation of this type of distribution, such as training, counseling, and ensuring supply.

The checklist included in the kit is based on the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use.

For FHI’s English-language toolkit on community-based distribution click here.

To see INFO’s Injectables Toolkit click here.  

Want more on injectables? See the Population Reports guide to Expanding Service for Injectables.

From Maxine Eber at Population Services International:

We are seeing an extremely strong bias among providers against DMPA in favor of NET-EN. The reasons are the issues of bone mineral density,delayed return to fertility, and amenorrhea. Return to fertility and overall safety seem to be the 2 biggest issues. It is believed that DMPA is less reversible and less safe than NET-EN. I understand that there are some differences in the time it takes to return to fertility, but that these are minor and I’m afraid that they are getting blown out of proportion.

Sanjay Chaturvedi from the IndiaCLEN Programme Evaluation Network writes:

Sir,

This is regarding the Jan-Feb 2007 issue of Population Reports – “Expanding services for injectables”. While agreeing with the sentiment and some of the technical assertions made, we wish to register our reservations on the broad messages that (may be inadvertently) go with the cover story, its title, and accompanying photograph.

We, in partnership with Govt. of India and World Bank, have recently conducted a nation-wide study on injection practices.1 It would be relevant to place some of the findings here. The burden of injections was 5.8 injections (95% CI 5.3-6.3) per person per year. Overall 44.1% of all outpatient clients were prescribed injections, and in nearly 80% of them, the oral alternatives were available. Of all the injections administered in India, 31.6% [95% CI 29.4-33.0] carried a potential risk of transmitting Blood Borne Virus. Unsafe injection due to faulty technique was observed in 53.1% [95% CI 50.8-55.4]. This made nearly two third (62.9 %; 95%CI 60.7-65.0) of the injections unsafe.

This is to be emphasized here that we are also striving for the provision of quality injection services in all settings. Our network is engaged in country-wide ‘Model Injection Centre Project’ in program mode for last 2 years (http://www.ipen.org.in/index.php?option=content&task=view&id=237&Itemid=287&parent=225). Nevertheless, our primary objective is to reduce the burden of injections, at the first place. All the health organizations and functionaries working in developing countries need to be extra careful in promoting injectables, wherever effective oral alternatives are available.

We are afraid that while your aim is to stress upon the importance of quality services for injectables (if opted), the message that sticks is – ‘Just go for the injectables!’ This is worrisome, particularly in the context of low and middle income countries.

With best regards,

Yours sincerely,

Sanjay Chaturvedi
on behalf of:
IndiaCLEN Programme Evaluation Network (IPEN), New Delhi