Reaching Each Rung of the Health Care Ladder
We work to ensure access to—and use of—high-quality, safe and effective voluntary family planning. We work with individuals and communities to explain the variety of contraceptives and how they work, while addressing beliefs and behaviors around their availability and use. We support facilities and providers in efficiently delivering quality family planning services. And we work with governments and other stakeholders to shape an environment that supports consistent delivery and use of family planning methods.
Our Multipronged Approach
Recognizing the need to provide girls and women with effective and safe voluntary family planning appropriate to their situation, we work to incorporate a variety of methods into the contraception menu. These include client-controlled methods such as the lactational amenorrhea method, oral pills, condoms, standard days method (CycleBeadsTM or apps such as iCycle), progesterone contraceptive vaginal rings, emergency contraceptive pills and self-injectables; long-acting and reversible contraceptives, such as copper or hormonal IUDs and various brands of implants; and permanent methods such as male and female sterilization. We help countries expand the range of options offered after birth or miscarriage and before discharge to include IUDs, implants, sterilization and a range of short-acting methods.
By integrating voluntary family planning and reproductive health care with other services, such as antenatal and intrapartum, maternal, infant and young child health nutrition and immunization, we can extend our reach and address women’s unique needs at different life stages. For example, we support messaging on the use of family planning in the first year after giving birth, during antenatal care (ANC), through innovative approaches such as group ANC. We also support the development of family planning counseling messages and service integration job aids for HIV service providers to help them meet the needs of their clients at risk of acquiring, or living with, HIV.
Our approaches are informed by user insights, drawing on the contraceptive preferences and needs within a community and the ways in which clients and health care providers could be organized to deliver on those needs, and then working with governments and other stakeholders to meet them. We promote distribution of contraceptives by community health workers and through community-based programs, as well as through pharmacies and accredited drug dispensaries and outlets, and encourage integration of innovations such as self-injectables within those channels. We also work to ensure that women receiving post-pregnancy care have the option of spacing future pregnancies by accepting a family planning method before leaving the facility.
Effective counseling is fundamental to high-quality family planning services. Trained health care workers who respectfully and knowledgeably counsel women and families on their voluntary family planning options, respecting a woman’s right to determine whether to use family planning and what method suits her at the time that they provide these services, increase method uptake and continued use. We develop and implement onsite training, mentorship and supportive supervision for health care workers across the health care system. We support both pre-service and in-service education through curricula, lesson plans and clinical practice emphasizing competence and performance, behavioral drivers of quality care provision, on-the-job practice, mentorship and supportive supervision. We promote task-sharing, such as educating lay health workers, nurses, midwives, pharmacist and pharmacy assistants and other nonphysician providers to administer various contraceptive methods.
We support ministries of health to institutionalize voluntary family planning provision in their countries’ health systems. We advocate for and draft policy documents, national and subnational costed implementation plans for family planning, and service delivery guidelines that incorporate World Health Organization medical eligibility criteria and practice recommendations, including postpartum family planning (PPFP) guidance and measurement of family planning quality indicators and PPFP uptake. For example, with our support, improved contraceptive services in India have saved the lives of an estimated 86,000 children and 10,000 women in the past six years.
In all of our programs, we seek out innovations to increase our impact. From preparing frontline health workers to deliver voluntary family planning services, including new contraceptive methods in their markets, to expanding uptake of postpartum and postabortion family planning, to advocating for programs and policies to increase access to contraception for adolescents and first-time parents and new indicators in health management information systems to track family planning program performance, Jhpiego champions innovative ideas that will ensure that individuals everywhere can choose and consistently use the voluntary family planning methods that best suits their needs.
With Jhpiego’s support, in the past six years, improved contraceptive services in India saved the lives of an estimated 86,000 children and 10,000 women.
Jhpiego currently supports family planning and reproductive health care programs in 25 countries. The programs listed here give a snapshot of our work in this critical area.
The United States Agency for International Development (USAID)-funded MOMENTUM Country and Global Leadership project, led by Jhpiego, provides targeted technical and capacity development assistance to Missions, partner countries and local organizations; and contributes to global technical leadership and policy dialogue for improved maternal, newborn and child health, voluntary family planning and reproductive health outcomes. Family planning enables women to space pregnancies or, for families who already have the desired number of children, limit additional pregnancies. Spacing pregnancies two or three years apart gives women time to regain their strength and gives babies time to thrive. MOMENTUM strives to increase access to quality voluntary family planning care as a central strategy for reducing maternal and child mortality in USAID partner countries.
Jhpiego hosts one of four TCI regional hubs, which is funded by the Bill & Melinda Gates Foundation and Bayer, Inc, through the Bill & Melinda Gates Institute for Population and Reproductive Health. Through the East Africa regional hub, Jhpiego is assisting Tanzania, Kenya and Uganda to scale up family planning services to reach additional women and girls. TCI’s technical assistance model incentivizes local governments, private sector entities and donors to buy into the most successful and high-impact family planning interventions, rapidly adapt them to the local context, efficiently scale them up and mobilize local resources to sustain these programs, systems and services beyond a local challenge grant’s graduation.
Since 2013, the introduction and scale-up of contraceptive implants have unequivocally increased access to family planning method choice worldwide. As the uptake of contraceptive implants continues on a remarkable trajectory, and the product is fully mainstreamed into family planning programs, a concerted effort to ease implants off dedicated product support is needed, and attention toward remaining market and access challenges (e.g., product and service availability in the private sector) is crucial. With funding from the Bill & Melinda Gates Foundation, Jhpiego expands method choice through updated models of product stewardship and market development for post-introduction contraceptive technologies (such as implants). To do this, Jhpiego collaborates with stakeholders to evolve product coordination bodies, uses service delivery insights to improve implant market health, and expands access to implants in the private sector.
With funding from Margaret A. Cargill Philanthropies, Jhpiego is implementing a project to improve maternal, newborn and child health by increasing coverage of high-quality PPFP services in 12 districts in Indonesia and leveraging the country’s existing PPFP gains and momentum. Applying the World Health Organization’s Health Systems Building Blocks framework, the project addresses gaps related to health workforce, information, contraceptives, financing, leadership/governance and community barriers, as well as gaps associated with introducing PPFP services. The project will also generate practical recommendations for wider PPFP scale-up as part of the Government of Indonesia’s initiatives. It will take special considerations to ensure continuity of PPFP service delivery during and after the pandemic.
This five-year project seeks to increase access to, and equitable use of, high-quality, gender-sensitive and integrated nutrition and reproductive, maternal, newborn, child and adolescent health services (including family planning and water, sanitation and hygiene) in the Western Highlands of Guatemala. The project aims to reach more than 400 communities, with a 5% reduction in stunting, 35% reduction in newborn mortality, 22% reduction in child mortality and 34% reduction in maternal mortality in selected regions. Jhpiego is implementing this work, funded by the U.S. Agency for International Development, in partnership with Instituto de Nutrición de Centroamérica y Panamá (INCAP), Asociación de Servicios Comunitarios de Salud (ASECSA) and Project ECHO.
The Jhpiego-led, five-year Integrated Family Health Services Project (IFHS) supports the Government of Burkina Faso to increase access, equity and uptake of quality, gender-sensitive, integrated services for malaria and reproductive, maternal, newborn, child and adolescent health and nutrition in 19 districts in the Centre-Est, Centre-Ouest and Sud-Ouest regions. Using a client-centered approach, with a focus on marginalized and vulnerable populations, the project is minimizing missed opportunities and providing timely, targeted care. IFHS is expanding use of a digital health platform at all levels of the health system in the targeted regions to promote quality integrated service delivery and improve data quality and use of data for clinical decision-making and management. Other consortium members of the U.S. Agency for International Development-funded project are Terre des Hommes, Viamo and local organizations Conseil Burkinabe des Organisations de Développement Communautaire and Association Songui Manegré/Aide au Développement Endogène.
Jhpiego technical experts regularly publish in peer-reviewed journals on topics ranging from group antenatal care messaging to screening and counseling to integration of family planning services with infant and young child nutrition and HIV treatment programs.
Learning Resource Packages & Toolkits
- Ensuring Quality Family Planning Services during the COVID-19 Pandemic. In April 2020, Jhpiego released guidance to ensure that family planning services continue to be treated as an essential right for women and families during the pandemic, while protecting the health and safety of health care providers, clients and communities. Developed to respond to an urgent need, this guidance has relevance for protecting continuity of services in the event of future public health emergencies.
- Operational Guidance for Continuity of Essential Services Impacted by COVID-19: A practical guide for program implementation and adaptation. This guidance synthesizes global recommendations, current best evidence and critical resources to help health care providers, managers and leaders maintain essential health services, including family planning, during and after the pandemic or other public health emergency, and ensure that families receive the care and treatment they need and deserve.
- Skills Update for Contraceptive Implant Side Effect Management and Removal Learning Resource Package. This toolkit includes an implementation guide, facilitator guide and learners workbook with information and skills updates on managing implant side effects and implant removal.
- Providing Long-Acting Reversible Contraception (LARC) Learning Resource Package. This integrated learning package focuses on providing high-quality, long-acting reversible contraception services using a modular, facility-based approach for training, capacity-building and mentorship.