Reaching the unreached with family planning in India

A Janani mobile family planning van registers new users in India.

This blog was first published by Impatient Optimists blog on March 13, 2015.

By the time the brightly colored family planning van pulls into the government health center in a village in northern India, a group of young women is waiting. They have come to adopt a high quality modern method of contraception. They have already been pre-screened and most have chosen either an intrauterine device (IUD) or tubal ligation but the van also offers methods like condoms, oral contraceptives, injectables and emergency contraceptives, according to their needs.

Some of them have three, four or more children, and want no more. For many of them, it is the first time they have practiced family planning. The fertility rate in the states of Bihar and Uttar Pradesh, according to the last India National Family Health Survey 2005-2006, was 4.0 and 3.82 children respectively, the highest and second highest in all of India.

Some 270 such “mobile family planning days” were conducted in 2013 and 2014 in a pilot project with one van, creating 2,800 new IUD clients, and counseling 1,600 women who came for follow-up visits. With support from The Bill & Melinda Gates Foundation — in partnership with CARE, the University of Manitoba and Marie Stopes International — this program has expanded from one to 20 outreach teams that provide IUD and sterilization services for women, and non scalpel vasectomy for men. The operation is run by Janani, an affiliate of the international social marketing organization DKT International.

Stymied by Less Smoking in Richer Countries, Big Tobacco Shifts Focus on Developing Countries

Anti-tobacco demonstrators in Brazil demand implementation of the national Tobacco Control Law. Credit: Aliança de Controle do Tabagismo

This was originally published by Global Health TV on March 2, 2015.

Between 1990 and 2009, cigarette consumption decreased by 26% in Western Europe, but in Africa and the Middle East, it increased 57%, according to the American Cancer Society (ACS). In response, many of these developing countries are stepping up their efforts to fight tobacco with new laws and restrictions. Big Tobacco is using its deep pockets to finance creative attempts to circumvent those laws.

The problem is so daunting that ACS named rising use of tobacco in developing countries as one of it “Three Top Cancer Challenges of the 21^st Century” earlier this month when it observed World Cancer Day. Comedian John Oliver covered the issue very well in this segment from his HBO show “Last Week Tonight.”

An estimated 8 million of the 14.1 million new cancer cases diagnosed in 2012 occurred in developing countries with 82% of the world’s population, according to Global Cancer Facts & Figures, 3^rd Edition. Smoking causes at least 12 types of cancer, according to the U.S. Surgeon General, and accounts for a fifth of all global cancer deaths. Tobacco use is the cause of nearly 6 million premature deaths annually, notes the report.

Family planning in India and Pakistan: Picking up the pace of change

Birula, living in Bihar, India, was all smiles about her sterilization. 
Photo: David J. Olson

This blog was originally published by Global Health TV on Jan. 27, 2015.

WALLAH, Pakistan and ARA, India -- Last month, I met Sumeera, 26, in a Dhanak clinic (“dhanak” means rainbow in Urdu) in the village of Wallah, in the rural Punjab of Pakistan. She and her husband have four children ages 7, 5, 3 and 1, and have agreed that four is enough. She had come for a pregnancy test and to secure a contraceptive method to keep her family from getting bigger. Her pregnancy test was negative, and she went away happily, with an intrauterine device inserted by her Dhanak midwife and clinic owner Kaneez Fatima. “Before we found Dhanak, my husband and I knew about family planning but did not have access to it,” Sumeera told me. “Dhanak made a big change in my life.”

One thousand four hundred kilometers to the southeast and a week later, I met Birula, 25, in a Surya clinic (“surya” is the Hindi word for sun) in Ara, a rural town about two hours outside of Patna, India, the capital of Bihar state. She has three children ages 7, 6 and 1½. The previous week she had been sterilized at this clinic; she was back to have her stitches removed. Her relief was palpable – she couldn’t stop smiling.

Sumeera and Birula come from different cultures in different countries but the problems they face are remarkably similar – too many children and too little ability to control the size of their. In India, women cannot always determine the size of their families because of a strong preference for the male child and male dominance in decision-making. In Pakistan, religion also plays an influential role. Both countries are confronting the problem, albeit in different ways and with varying degrees of success.

The top 10 in contraceptive social marketing

Two salesmen from DKT India make a pitch for contraceptives to the owner of a pharmacy in the Mumbai slums. In 2013, DKT India was the ninth biggest contraceptive social marketing program in the world. 
Photo: David J. Olson

This was originally published on the Knowledge4Health Blog on Dec. 23, 2014.

Social marketing organizations around the world delivered more impact than ever before in 2013 —70 million couple years of protection (CYPs), an increase of 6.8% from the 65.5 million CYPs produced in 2012, according to the 2013 Contraceptive Social Marketing Statistics just published by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article for more details).

The report provides details on 93 contraceptive social marketing programs in 66 countries, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries.

The social marketing program producing the most CYPs in 2013 was DKT Indonesia, delivering 6.7 million CYPs, consisting of contraceptives sold through social marketing channels such as pharmacies, convenience stores and medical wholesalers. The second biggest program was the Government of India, with 5.8 million CYPs (although over 40% of these CYPs were for products given out for free, which was not the case with other programs in the Top 10). Here is the Top 10 list in contraceptive social marketing in 2013:

1. DKT Indonesia, 6.7 million CYPs

2. Government of India, 5.8 million CYPs

3. Social Marketing Company (SMC), Bangladesh, 4.44 million CYPs

4. Greenstar Social Marketing, Pakistan, 4.42

5. PSI India, 3.8 million CYPs

6. Society for Family Health, Nigeria, 3.4 million CYPs

7. Population Health Services India, 3.3 million CYPs

8. DKT Ethiopia, 3.1 million CYPs

9. DKT India, 2.89 million CYPs

10. Profamilia, Colombia, 2.87 million CYPs

The top 10 global health stories of 2014

This was originally published by Global Health TV on Dec. 22, 2014.

Ebola, the biggest global health story of the year, is one that no one could have predicted when the year dawned almost 12 months ago. It did something that few global health stories do: It entered the consciousness of the global public in an important way. Beyond Ebola, though, there was much to celebrate in 2014.

Ebola: That one word represented not only the biggest global health story of the year, but one of the biggest stories of the year, of any type. As of Dec. 17, the World Health Organization (WHO) reported 18,603 cases and 6,915 deaths. Late in the year, incidence was declining in Liberia, slowing in Sierra Leone and “fluctuating” in Guinea. Sierra Leone surpassed Liberia as the country with the most reported cases. As I wrote here on Global Health TV last month, Ebola has made the definitive case for stronger health systems and health workers in developing countries.

Reaching adolescents with the right kind of HIV and sexual health services

Pacifique, who was born HIV-positive, has finally found a safe space.

This was originally published on the ONE Blog on Dec. 4, 2014.

Pacifique is a 20-year-old student living in Bujumbura, Burundi, who found out he was born HIV-positive when he was 10 years old. He had been taking anti-retroviral medication for a year without knowing what it was for.

“My mum refused to disclose my status to me,” recalled Pacifique. “She told me I had a heart problem but that I would get better. I was frightened when I found out. I thought I would never get married. It hurt me to think I would never have children.”

Pacifique is hardly alone. There were an estimated 2.1 million adolescents living with HIV in 2012, with more than 80% of them living in sub-Saharan Africa. Many don’t know their HIV status. HIV is now the number one cause of adolescent mortality in Africa and the second biggest in the world (UNAIDS defines adolescents as ages 10-19). Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%.

Young people most affected by HIV finally gain a seat at the table

Link Up aims to improve the sexual and reproductive health and rights of more than one million young people living with and most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. Here's a group of young people above in Ethiopia. Credit: International HIV/AIDS Alliance

This blog was originally published by the Huffington Post on Dec. 1, 2014.

Earlier this year, young Ugandans saw an opportunity to influence the HIV response in their country by coming together to determine their priorities for the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a major funder of HIV programs.

The meeting included young members of “key populations,” including people living with HIV, people who use drug, sex workers, transgender persons, men who have sex with men, fisher folk and truckers, and was facilitated by young women living with HIV. These young people are rarely consulted in a meaningful way in the design and implementation of HIV/AIDS programs, even programs targeting them, in Uganda and globally.

These priorities were eventually shared in the form of a Young Key Populations Priorities Charter. The priorities identified provided a template for action that, if accepted by the Global Fund, could lead to more effective programming for young people, increased engagement by young people in policy development and national planning processes and, ultimately, genuine change on the ground.

This is one example of how young people, and particularly those living with HIV and from these key populations, are starting to engage meaningfully in the design and implementation of HIV/AIDS programs meant to help them, something long past due.