<div class="title-block" style="border-bottom-color: #628bb3"><h1><img class="title-image" src="http://www.heart-resources.org/wp-content/themes/heart/images/health.svg">Sexual and Reproductive Health</h1><div class="post-type-description"></div></div> – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Rights-based approaches to increasing access to Sexual and Reproductive Health and Rights http://www.heart-resources.org/2016/07/rights-based-approaches-increasing-access-sexual-reproductive-health-rights/ http://www.heart-resources.org/2016/07/rights-based-approaches-increasing-access-sexual-reproductive-health-rights/#respond Thu, 21 Jul 2016 20:28:49 +0000 http://www.heart-resources.org/?p=29314 Read more]]> This helpdesk report provides an overview of some of the most relevant evidence on rights-based approaches to increasing access to SRHR including how they have been measured and enhanced access where information is available. Section 2 of this report explores the impact of policy changes on accessing rights, and the impact that champions of SRHR within the government can have on the broader population’s access to information and services. Section 3 on improved services includes a programme in Guatemala which increased patients’ capacity to make informed contraceptive choices by reorganising and improving the content of consultations. Section 4 on female-focussed approaches includes a study which found that community-based interventions, particularly where village women provide basic health and family planning counselling to other women, had great success in overcoming barriers to access to contraception. In Section 5, two notable programmes were identified that discussed male-focussed approaches to improving access to SRHR. Section 6 focuses on broader approaches to increasing access to SRHR.

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Increasing access to sexual and reproductive health and rights via new innovations and technologies in Africa http://www.heart-resources.org/2016/07/increasing-access-sexual-reproductive-health-rights-via-new-innovations-technologies-africa/ http://www.heart-resources.org/2016/07/increasing-access-sexual-reproductive-health-rights-via-new-innovations-technologies-africa/#respond Thu, 21 Jul 2016 13:32:10 +0000 http://www.heart-resources.org/?p=29310 Read more]]> New innovations and technology, including mobiles and internet, have enormous potential for increasing access to sexual and reproductive health and rights (SRHR). They can be particularly helpful in reaching hard to access groups, including remote or stigmatised populations, due to the rapid spread of telecommunications infrastructure, mobile phones and broadband usage in low and middle income countries. This helpdesk report explores the evidence around innovations and technologies that increase access through broadening the availability and reach of information and services. Some of the papers on innovations and technologies identified in this helpdesk report do not quantify the increases in users but have been included regardless if they describe an interesting approach. This helpdesk report provides a snapshot of some of the most relevant evidence currently available.

The evidence suggests that mobile phones are extremely useful for increasing access to SRHR, both through educating the public directly or providing information to health professionals. Information can be provided directly or referrals made to clinics or other centres for accessing SRHR. Key challenges include a low proportion of the population owning mobile phones in some areas or lack of funds to charge them, and certain groups, including women, those over 45 and socio-economically disadvantaged groups being less likely to have access to a phone. Web-based approaches are also very useful in increasing access to SRHR. This includes online health education programmes, websites and social media platforms. These services are very popular for accessing information and are often described by users as non-judgmental and authoritative. Many clients are then referred on to other services. Challenges include lack of access to computers and embarrassment at visiting sites referring to SRHR in public. Mixed approaches were also common among programmes to increase access to SRHR and were found to be largely very successful in achieving their goals.

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Access to family planning and safe abortion http://www.heart-resources.org/2016/07/access-family-planning-safe-abortion/ http://www.heart-resources.org/2016/07/access-family-planning-safe-abortion/#respond Thu, 21 Jul 2016 11:03:09 +0000 http://www.heart-resources.org/?p=29304 Read more]]> A WHO systematic review looking at the evidence on sexual and reproductive health among adolescents in developing countries finds quality evidence to be lacking in many areas (WHO, 2012). The report includes the following:

  • No evidence was found on the efforts to influence laws and policies though this is recognised as important for increasing access.
  • Efforts at increasing access to contraceptives directed at community leaders is acknowledged as useful but no evidence was eligible. Attribution is particularly difficult in this area. Potential harms of community interventions are noted.
  • Some evidence was found to suggest that health service improvements can improve access. There are no harms in these areas and the panel recommends health service improvement for improving access.
  • Low quality evidence was found to suggest that over-the-counter hormonal contraception improves access. There can be problems with misinformation and lack of follow-up with this type of provision.

Evidence suggests that pills and injectable contraceptives can be safely provided at the community level by community health workers (CHWs) and through the retail sector. Provision of injectables by CHWs has been delivered to as high a standard as provision by nurses and midwives in Uganda according to one study. Technical experts have endorsed safety of the practice also. Research on the provision of injections in pharmacies suggests practices are often unsafe.

Evidence on increasing access to safe abortion includes:

  • A successful programme in Ethiopia has reduced unsafe abortion cases by deploying health extension workers to provide services. Health centres and hospitals also increased services also. The project ensured involvement of women and community leaders.
  • Efforts to increase availability of safe abortion at the University Teaching Hospital, Lusaka, Zambia was found to increase uptake.
  • A study was identified looking at the feasibility of introducing medication abortion in KwaZulu Natal, South Africa.
  • Provision of safe abortion services was successfully increased with the ‘Reducing Maternal Mortality and Morbidity’ (R3M) in Ghana.
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Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries http://www.heart-resources.org/doc_lib/preventing-early-pregnancy-poor-reproductive-outcomes-among-adolescents-developing-countries/ http://www.heart-resources.org/doc_lib/preventing-early-pregnancy-poor-reproductive-outcomes-among-adolescents-developing-countries/#respond Thu, 21 Jul 2016 10:53:37 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=29305 Read more]]> The WHO guidelines, Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries, provide both a call to action and directions for future research on:

  • preventing early pregnancy: by preventing marriage before 18 years of age; by increasing knowledge and understanding of the importance of pregnancy prevention; by increasing the use of contraception; and by preventing coerced sex; and
  • preventing poor reproductive outcomes: by reducing unsafe abortions; and by increasing the use of skilled antenatal, childbirth and postnatal care.

They are primarily intended for policy-makers, planners and programme managers from governments, nongovernmental organizations and development agencies. They are also likely to be of interest to public health researchers and practitioners, professional associations and civil society organizations.

They have been developed through a systematic review of the evidence and through consultation with policy-makers, programme managers and front-line workers from countries around the world, in partnership with many key international organizations working in this field – the Guttmacher Institute, the International Center for Research on Women (ICRW), FHI 360), the Population Council, and Centro Rosarino de Estudios Perinatales, CREP (Argentina).

Their development has been supported financially by the United Nation Population Fund (UNFPA), the United States Agency for International Development (USAID), and the International Planned Parenthood Federation. (IPPF) Similar partnerships have been forged to distribute them widely and to support their use.

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Targeted interventions for sex workers to reduce HIV http://www.heart-resources.org/2016/07/targeted-interventions-sex-workers-reduce-hiv/ http://www.heart-resources.org/2016/07/targeted-interventions-sex-workers-reduce-hiv/#respond Sat, 16 Jul 2016 15:04:53 +0000 http://www.heart-resources.org/?p=29189 Read more]]> This review has found a number of peer reviewed studies and grey literature on interventions targeted at sex workers for HIV prevention. Several were systematic reviews, some comprehensive reviews and policy papers. A number of individual studies focused on cost effectiveness are presented.

Two interventions in India are considered particularly effective and scalable interventions. A number of studies on these is presented. Both of these programmes focus on community mobilisation, and involve female sex workers (FSWs), as well as other key groups.

The key messages identified are:

  • The evidence for the cost-effectiveness of FSW interventions is strong, particularly for areas with concentrated HIV epidemics, with an estimated average cost of $102 to $184 per participant. Cost analyses demonstrate the cost-effectiveness of scaling up HIV prevention and treatment among sex workers, particularly in higher prevalence settings where it becomes cost-saving.
  • Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. Additionally, programmes should be holistic and complementary.
  • HIV prevention strategies should target the social determinants of health and inequality. The literature on HIV interventions targeting FSWs underscores the inextricable connections between gender, political-legal, and economic structures on the vulnerability of FSWs and their susceptibility to HIV.
  • Community empowerment is an essential approach, as is community participation and leadership.
  • Ultimately, structural and legal changes that align public health and human rights are needed. In the short term, interventions targeted at sex workers could contribute to reducing HIV risk.
  • Evidence is primarily available for interventions with FSWs.
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Cost-effectiveness of interventions for improving adolescent sexual and reproductive health http://www.heart-resources.org/2016/07/cost-effectiveness-interventions-improving-adolescent-sexual-reproductive-health/ http://www.heart-resources.org/2016/07/cost-effectiveness-interventions-improving-adolescent-sexual-reproductive-health/#respond Sat, 16 Jul 2016 14:42:46 +0000 http://www.heart-resources.org/?p=29200 Read more]]> Research on the cost-effectiveness of interventions to improve SRH for adolescents is limited. This rapid review includes research on some interventions which focus specifically on girls and some research on programmes for both boys and girls.

Three studies were identified that specifically analysed cost-effectiveness of SRH interventions for adolescents in low- and middle-income countries (see full report for references):

  • A randomised intervention in Kenya delivered teacher training on the national HIV/AIDS curriculum, which focuses on abstinence until marriage. Risk reduction strategies (such as condom use or selection of safer partners) were not discussed. It is estimated that the information campaign cost was just under US$100 per cross-generational pregnancy averted. A cost of US$653 is estimated per primary HIV infection averted among teenage girls (this does not include averted secondary infections).
  • A study in Botswana looking at secondary schooling as an HIV prevention intervention estimates cost-effectiveness ratios (CERs) of US$4,387/disability-adjusted life year (DALY) with antiretroviral therapy (ART) and US$1,703/DALY without ART. CERs less than per capita GDP (US$5,178 in this case) are deemed to be very cost-effective. The large benefits of secondary schooling beyond HIV transmission are excluded from the calculation. Education of girls is particularly important.
  • A competitive voucher scheme in Nicaragua was studied for cost-effectiveness but identified cost per sexually-transmitted infection (STI) cured rather than cost per prevention. The estimate was that the intervention cost US$118 per STI cured. Without the scheme, the cost estimate was US$200 per STI cured.
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Cost-effectiveness of male circumcision in reducing HIV http://www.heart-resources.org/2016/07/cost-effectiveness-male-circumcision-reducing-hiv/ http://www.heart-resources.org/2016/07/cost-effectiveness-male-circumcision-reducing-hiv/#respond Sat, 16 Jul 2016 14:40:09 +0000 http://www.heart-resources.org/?p=29185 Read more]]> Evaluation of the evidence on the effectiveness of male circumcision (MC) suggests that implementation should be accelerated in sub-Saharan Africa. Experts reviewing six simulation models agree that programmes that focus on subpopulations with a high HIV prevalence and incidence would have substantial impact on HIV incidence.

The review of the six simulation models found estimates of costs per HIV infections averted (HIA) between $150 and $900 in high HIV prevalence settings over a 10-year time horizon, and $100 to $400 when including infections averted to 20 year. Cost-effectiveness models from individual studies estimate (download the full report for references):

  • With an HIV prevalence of 8.4%, the cost per HIA is $551 (80% CI $344–$1,071) and net savings are $753,000 (80% CI $0.3 million to $1.2 million) based on data from South Africa.
  • Research using data from Uganda estimated the cost per HIA to be $1,269–3,911.
  • Modelling impact and costs of MC for Eastern and Southern Africa research estimates net savings for Zimbabwe to be US$7,031 for 2011-2025.
  • Costs per HIA based on Rwandan data is US$3,932 for adolescent MC and US$4,949 for adult MC. This study also investigated neonatal MC which is considerably less expensive, US$15 instead of US$59 per procedure, though savings will be realised later in time.
  • Estimates from Tanzanian data suggest costs per HIA to be US$11,300 during 2010–2015 and US$3,200 during 2010–2025.
  • The USAID Health Policy Initiative estimated cost-effectiveness in the settings of Swaziland, Zambia, and Lesotho. Costs per HIA were US$176 in Swaziland, US$313 in Zambia, and US$292 in Lesotho.

Value-added from male circumcision comes from reduction in other sexually transmitted diseases.

Cost-effectiveness estimates identified are promising but vary widely, making it difficult to draw conclusions. Estimates are sensitive to inputs such as costing of the MC and treatment averted, the protective effect, and HIV prevalence. Estimates are also likely to vary over time due to inflation.

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Adolescent sexual and reproductive health http://www.heart-resources.org/2016/06/adolescent-sexual-reproductive-health/ http://www.heart-resources.org/2016/06/adolescent-sexual-reproductive-health/#respond Tue, 28 Jun 2016 09:01:54 +0000 http://www.heart-resources.org/?p=29181 Read more]]> This helpdesk identified a number of reviews on adolescent SRH. Key findings include:

  • Facilitating school attendance reduces childbearing and schools are an effective platform for reproductive health education.
  • To improve access and use one review recommends: enacting and implementing laws and policies requiring education and reproductive health services, building community support for contraception provision; providing sexuality education within and outside of school settings; and making health services adolescent-friendly.
  • Adolescent childbearing and early marriage are detrimental to girls’ health, school completion, and long-term earning potential, and their babies’ health and development, contributing to poverty at the household and national level.
  • Involving adolescents in the planning process improved effectiveness, as did programmes sustained over long periods.
  • Social marketing and behaviour change communication interventions have been effective in increasing contraceptive uptake, but had low impact on effective use and continuation.
  • Mobile phones and social media are promising means of increasing contraceptive use among adolescents.
  • A rights-based approach to adolescent fertility is recommended and shifting focus from the proximate to distal causes of pregnancy, including human rights abuses, gender inequality, child marriage, and socioeconomic marginalisation.
  • In providing adolescent friendly services recommended approaches use a combination of health-worker training, adolescent-friendly facility improvements and broad information dissemination via the community, schools, and mass media.
  • Cash transfers are effective in motivating change in a variety of settings.

Difficulty in drawing conclusions on the best practice for improving SRH for adolescents is noted within many of the reviews.

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Quality of care in maternal, newborn and child health (MNCH) and sexual and reproductive health (SRH) http://www.heart-resources.org/2016/06/quality-care-maternal-newborn-child-health-mnch-sexual-reproductive-health-srh/ http://www.heart-resources.org/2016/06/quality-care-maternal-newborn-child-health-mnch-sexual-reproductive-health-srh/#respond Tue, 28 Jun 2016 08:59:40 +0000 http://www.heart-resources.org/?p=29175 Read more]]> This helpdesk query looks at interventions to improve the quality of care in maternal, newborn, and child health (MNCH) and sexual and reproductive health (SRH). It includes evidence assessing which interventions are likely to have the best impact on service outputs and health outcomes, with an emphasis on cost effectiveness.

The MNCH focus is on the importance of continuum of care interventions. Continuity of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood) and also between places of caregiving (including households and communities, outpatient and outreach services, and clinical-care settings). Several high quality studies have reviewed the literature and assessed different interventions and their outcomes, and provide an excellent overview of which are likely to have the greatest effects on health outcomes and service delivery.

A section of this report is dedicated to the issue of cost effectiveness and includes several diagrams which can be used to assess this issue as well as a study showing key ways to improve cost effectiveness including increasing spending, efficiency, equity and ensuring there are incentives and integration.

The report then looks at SRH. Health and rights in sexuality and reproduction are an integrated package, which includes SRH services comprehensive sexuality education; and protection of SRH and rights. People cannot be healthy if they have one element of the package but miss others. Progress on the components of SRH and rights has been uneven. While acknowledging that certain components may be more difficult or more costly to implement, progress in many instances has been hindered on ideological, rather than scientific, public health and cost-effectiveness grounds. There have been many accomplishments but aggregate gains mask stark inequalities, with low coverage of services for the poorest women.

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Evidence for the greater cost-effectiveness of long acting methods in family planning http://www.heart-resources.org/2016/06/evidence-greater-cost-effectiveness-long-acting-methods-family-planning/ http://www.heart-resources.org/2016/06/evidence-greater-cost-effectiveness-long-acting-methods-family-planning/#respond Mon, 27 Jun 2016 12:35:19 +0000 http://www.heart-resources.org/?p=29170 Read more]]> The key message from the evidence that although long acting and permanent methods of contraception incur higher initial costs than short acting methods, the long term protection that they provide and substantially greater effectiveness at preventing unintended pregnancies means that their overall cost-effectiveness is higher. Research included in this review describe this key message, including providing data identifying IUDs and sterilisation as having the lowest annual direct costs. The IUD is identified as being the most cost-effective method of contraception available. Average direct costs are found to be highest for implants, injectables and pills. There is evidence suggesting that if used for at least three years, the IUD, vasectomy and implant are the three most cost-effective methods of contraception when all direct medical costs including unintended pregnancies are taken into account. Long acting and permanent methods of contraception are reported to be between three and 60 times more effective than short acting methods, and that continuation rates for these methods are much higher.

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