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Reproductive Health

, 9:27

First Online: 12 November 2012Received: 26 July 2012Accepted: 25 October 2012DOI: 10.1186-1742-4755-9-27

Cite this article as: Byrne, A., Morgan, A., Soto, E.J. et al. Reprod Health 2012 9: 27. doi:10.1186-1742-4755-9-27


BackgroundUnmet need for family planning is responsible for 7.4 million disability-adjusted life years and 30% of the maternity-related disease burden. An estimated 35% of births are unintended and some 200 million couples state a desire to delay pregnancy or cease fertility but are not using contraception. Unmet need is higher among the poorest, lesser educated, rural residents and women under 19 years. The barriers to, and successful strategies for, satisfying all demand for modern contraceptives are heavily influenced by context. Successfully overcoming this to increase the uptake of family planning is estimated to reduce the risk of maternal death by up to 58% as well as contribute to poverty reduction, women’s empowerment and educational, social and economic participation, national development and environmental protection.

MethodsTo strengthen health systems for delivery of context-specific, equity-focused reproductive, maternal, newborn and child health services RMNCH, the Investment Case study was applied in the Asia-Pacific region. Staff of local and central government and non-government organisations analysed data indicative of health service delivery through a supply–demand oriented framework to identify constraints to RMNCH scale-up. Planners developed contextualised strategies and the projected coverage increases were modelled for estimates of marginal impact on maternal mortality and costs over a five year period.

ResultsIn Indonesia, Philippines and Nepal the constraints behind incomplete coverage of family planning services included: weaknesses in commodities logistic management; geographical inaccessibility; limitations in health worker skills and numbers; legislation; and religious and cultural ideologies. Planned activities included: streamlining supply systems; establishment of Community Health Teams for integrated RMNCH services; local recruitment of staff and refresher training; task-shifting; and follow-up cards. Modelling showed varying marginal impact and costs for each setting with potential for significant reductions in the maternal mortality rate; up to 28% 25.1-30.7 over five years, costing up to a marginal USD 1.34 1.32-1.35 per capita in the first year.

ConclusionLocal health planners are in a prime position to devise feasible context-specific activities to overcome constraints and increase met need for family planning to accelerate progress towards MDG 5.

KeywordsFamily planning Maternal mortality Health systems research Health planning Evidence based planning Indonesia Philippines Nepal AbbreviationsANMsAuxiliary nurse midwives

CHTCommunity health teams

CHWsCommunity health workers

CPRContraceptive prevalence rate

EmOCEmergency obstetric care

LGUsLocal government units

MDGMillennium development goals

MNCHMaternal, newborn and child health

MMRMaternal mortality ratio

TFPTotal fertility rate

USDUnited states dollar.

Electronic supplementary materialThe online version of this article doi:10.1186-1742-4755-9-27 contains supplementary material, which is available to authorized users.

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Autor: Abbey Byrne - Alison Morgan - Eliana Jimenez Soto - Zoe Dettrick


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