John W. Townsend

Comparison of condom breakage during human use with performance in laboratory testing

This paper combines results from a study of the determinants of condom quality and use conducted by The Population Council in two countries in the Caribbean with results from a condom breakage study conducted by Family Health International (FHI) in the United States. The studies, conducted two years apart, compared the breakage rates of condoms from the same lot during human use to their performance in laboratory test results. Breakage rates of 12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United States compared to passing ASTM laboratory tests suggest that existing laboratory tests as used with the current pass/fail standards are either not sufficiently sensitive or not well-defined to reliably predict condom performance during human use. The study also suggests that user behaviors and practices may be a factor in condom breakage. If the condom is to be an effective method against unplanned pregnancy and STD/HIV infection, and if consumer confidence is to be retained, condom breakage during sexual intercourse must be reduced.

Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach.

BackgroundThere is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.MethodsWe explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component.ResultsWe identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system.ConclusionsWe believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.

New strategies for providing hormonal contraception in developing countries.

Even with progress in increasing access to effective contraception over the past decades, and the growing range of contraceptive methods available on the market, women in developing countries continue to report an unmet need for family planning. This constraint continues to challenge reproductive health policies and programs, while the momentum of population growth and the young age structure in developing countries leads to larger numbers of potential contraceptive users and increasing global demand in contraceptive markets. Of late, there is a renewed focus on increasing access to long-acting hormonal methods to effectively meet this need, establishing and effectively implementing new service delivery strategies. A number of processes have profoundly affected the procurement and use of hormonal contraceptive methods in developing countries: a supportive policy environment, evidence-based practices and an increasing diversity of delivery strategies play a significant part in increasing number of contraceptive users and the demand for hormonal contraception.

Postabortion Care: Going to Scale

This commentary discusses the complementary efforts required to ensure that research findings associated with designing and delivering postabortion care services are utilized and scaled up. It describes the complementary efforts as ranging from identifying champions and advocates for postabortion care to providing technical assistance for replication and scale-up. It draws on specific country program experiences in sub-Saharan Africa Latin America and Asia where postabortion care services have been or have the potential to be scaled up.

Reproductive behavior in the context of global population.

In 1900, the worlds population was estimated at about 1.6 billion. With improved health and a youthful population, the worlds total population more than tripled to 6 billion by 1999. There is consensus that the worlds population will reach about 8.9 billion by 2050. Despite the persistent growth of population, the reproductive behavior of individuals and couples has changed significantly over the past 50 years with smaller families and lower fertility becoming the norm in many countries. Psychology not only may provide the theoretical frameworks and empirical insights into reproductive behavior but also can foster ways in which the debate on these highly personal issues can be productive for the welfare of people around the world.

Sexual Violence within Marriage: A Case Study of Rural Uttar Pradesh, India

A qualitative study of sexual violence within marriage in rural Bangladesh. The extent of and reasons for sexual coercion in marriage are analyzed and diagramed in a synthesis of the findings. Direct quotes from wives provide a realistic cultural context. Health education program interventions are suggested.

New vistas in contraceptive technology

Population forecasts predict that by 2050, about 150 million women (and couples) of child-bearing age will need contraception, and many of them are likely to find their needs unmet, due to problems of access, availability, and acceptability of the contraceptive options for one or both partners. Current contraceptive options are largely intended for use by women (pills, intrauterine devices [IUDs], injectables, and implants), with condoms and vasectomy being the only two options for men. In many countries, contraceptive use tends to be in the womans domain, in part due to the nature of the contraceptive. This article discusses how womens health advocates have been able to raise important concerns regarding contraceptive technology and its development. It also reviews the range of new contraceptives that addresses issues of user autonomy and controllability, offers protection against pregnancy and STIs and HIV, and addresses male needs and concerns.

A greenprint for sustainable contraceptive research and development

Commentary A greenprint for sustainable contraceptive research and development Kirsten Moore, John Townsend, Jeff Spieler, Patricia S. Coffey, Diana Blithe, Elizabeth Arndorfer, Elizabeth Dawes⁎ Reproductive Health Technologies Project, Washington, DC 20036, USA Population Council, Washington, DC 20008, USA United States Agency for International Development, Washington, DC 20523, USA PATH, Seattle, WA 98121, USA United States National Institutes of Health, Bethesda, MD 20892, USA

Do Women Find the Progesterone Vaginal Ring Acceptable? Findings from Kenya, Nigeria, and Senegal: Do Women Find the Progesterone Vaginal Ring Acceptable?

The progesterone vaginal ring (PVR) is a contraceptive designed for use by breastfeeding women in the first year postpartum. This Report presents results of an acceptability study of the PVR in Kenya, Nigeria, and Senegal. Women seeking postpartum family planning services were offered various contraceptive options including the PVR. Of the 174 participating women, 110 (63 percent) used one ring and 94 (54 percent) completed the study by using two rings over a six-month period. Women were interviewed up to three times: at the time they entered the study, at 3 months (the end of the first ring cycle), and at 6 months (the end of the second ring cycle or when they exited if they had discontinued earlier). Many participants found the ring to be acceptable, with over three-quarters reporting that it was easy to insert, remove, and reinsert. While a small proportion of women experienced ring expulsion, the majority did not. These findings suggest that even in countries with little or no use of vaginal health products, contraceptive vaginal rings offer women a new option that they are able and willing to use.