International Conference on Family Planning 2009

Family Planning: Research and Best Practices

The Conference Closes, The Mission Continues

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ICFP 2009 convened global experts to share the latest family planning research and practices that will advance the field and the well-being of families around the world. (Photo: Bangladesh/Shehzad Noorani)

The International Conference on Family Planning drew to a close this afternoon in a plenary that included a partners panel, award presentations, re-affirmation of global commitments to family planning, votes of thanks and comments by the Honorable Doctor Syda Bumba, Uganda Minister of State for Finance.

The closing sessions iterated and many of the points oft-heard during the last four days. Dr. Michael Mbizvo, of the WHO, called for action: “There is a sense of urgency. We have lost ground.”

Representing the Gates Foundation, Jose Rimon emphasized that the family planning community must spend money “the right way,” toward achieving the Millennium Development Goals, and he called for more and louder voices from sub-Saharan Africa.

Scott Radloff of USAID stressed a need for better strategies for reaching the poor, the undereducated, and those living in rural areas, suggesting that social marketing would be one effective measure.

Anthony Daly, of the UK Department for International Development, echoed a sentiment consistently throughout the conference: “We need integration [of family planning and HIV services] and harmonization,” he said, “and we need to have a mechanism to hold everyone accountable so we can better harmonize and integrate.”

Honorable Doctor Syda Bumba echoed the re-affirmations of commitment to family planning, acknowledging Uganda’s recognition of its importance.

Written by C. Grillo | JHSPH

November 18, 2009 at 11:11 pm

Posted in Nov. 18 Talks

New Collaboration: Advance Family Planning

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The Johns Hopkins Bloomberg School of Public Health, the David and Lucile Packard Foundation, USAID and the Bill and Melinda Gates Foundation announced on Wednesday at the ICFP conference a new three-year, $12 million project to advance reproductive health and family planning efforts in regions with the greatest need. The project, Advance Family Planning, will focus on sub-Saharan Africa and Asia.

“If we are serious about achieving the health component of the Millennium Development Goals,” said Jose Rimon, of the Gates Foundation, “we need to reinvest in and revitalize family planning and reproductive health. … This project can succeed only if the southern countries [of Africa] are united in owning the issues themselves.

Duff Gillespie, a professor at the Johns Hopkins Bloomberg School of Public Health, said, “The people who will really do the work and make it a success are individual champions in the countries they’re working in. We see our role as facilitating. We want to identify local champions and help them.”

For more information about the announcement, please visit

Written by C. Grillo | JHSPH

November 18, 2009 at 10:15 pm

Posted in Major Annoucements

Ward Cates: What Now?

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After two full days sharing research, ideas and knowledge, the question today at the ICFP is how to put the knowledge to action. Ward Cates, of Family Health International, opened today’s plenary by asking, “How do we do it?”

Cates spoke about the “pearls”—of knowledge, of wisdom—gathered over the last days. (Cates’s turn of phrase is more than appropriate: Uganda is known as the pearl of Africa.) Cates’s 10 points outline the areas of focus that he hopes will bring family planning renewed success and interest.

“Family planning is essential to achieving all of the Millennium Development Goals,” he said. Among the core issues discussed that deserve greatest attention are policies that address unmet contraceptive need; consistent and correct contraceptive use; contraceptive technology that makes adherence easy and cost-effective; and increased service delivery, so that all who wish to receive family planning have access to it.

Cates also tackled several of the newer issues that consistently surfaced at the conference. “I think we’ve reached a tipping point,” he said, in terms of getting countries on board with integrating family planning and HIV services. He also noted the growing acceptance of family planning as an effective HIV prevention strategy; the effectiveness of integrating family planning into other services such as postnatal and maternal and child health services; the need to get youth and men involved, particularly in reducing the taboos around vasectomy; reducing duplication among programs; and the importance of ownership of efforts by African leaders.

Written by C. Grillo | JHSPH

November 18, 2009 at 10:14 pm

Voices from the Frontlines: Call It “Healthy Timing”

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Adebusola Abidemi Salako is the Federal Minister of Health in Nigeria and works on family planning, reproductive health and family health issues.

“Now, we can say that the state of family planning in Nigeria is having a brighter look. Now acceptance is increasing, both among men and women, and even religious leaders. It all depends on the language you use, how you call it. In traditional parts of the country, we call it ‘healthy timing,’ or ‘childbirth spacing.’ ‘Family planning’ is not a good way to call it in those places. It is very important to change your language to suit the culture. … We need to get men involved not only in family planning, but in total reproductive health for the couple. When men are involved, the whole family benefits, and the country benefits.”

Written by C. Grillo | JHSPH

November 18, 2009 at 12:09 am

Voices from the Frontlines: Zero Tolerance of Maternal Death

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The Honorable Saudatu Sani is a member of the Nigerian House of Representatives, and chair of the Millennium Development Goals Committee in the House.

“I’m a champion of women’s health interests. … Our main challenge in Nigeria is human resources. We don’t have enough nurses or doctors. We can build the most beautiful clinics, but if we don’t have enough health care providers, we cannot help the 52,000 women who die every year in childbirth in Nigeria. … We are training 100,000 teachers to empower girls toward zero tolerance of maternal death. We are training teachers to talk to girls about their bodies, about health. Parliament is on the vanguard of committing to zero tolerance of maternal death. … I want to develop a Population and Development advocacy group within Parliament to promote maternal and child health.”

Written by C. Grillo | JHSPH

November 18, 2009 at 12:04 am

Voices from the Frontlines: Vasectomy Can Be Accepted

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Usman Gwarzo is a Family Health International, Nigeria program manager and country adviser for reproductive health and prevention of HIV transmission from mother to child. His organization is the largest PEPFAR-funded program in the world, and he is currently conducting research on a reproductive health and HIV integration project.

“Men are not the ones against vasectomy, but the myths are that vasectomy is castration. … When a man has more than one wife, he needs to have multiple negotiations about family planning. … The resistance to family planning is men, but vasectomy can be easily accepted so that the man does not have to worry about what happens to your children when you have more than you can support.”

Written by C. Grillo | JHSPH

November 17, 2009 at 11:57 pm

Are Hormonal Contraceptives Safe for HIV+ Women?

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Until recently, a dearth of data has made it difficult to counsel HIV-infected women about contraceptive options. In Africa, where the preferred birth control products are hormonal contraceptives such as pills and injectables, there has been some question about whether these methods would have an adverse effect on women who are already infected with HIV.

When Chelsea Polis, who just finished her doctoral degree at the Johns Hopkins Bloomberg School of Public Health, sought to answer this question, she found inconclusive research. Almost a dozen observational studies have provided mixed evidence, and the data’s validity is questionable. To design a new data collection effort, she would need to track women from the time of HIV seroconversion until they presented with AIDS or until they died—this could take 10 years or more. Fortunately, she Rakai Community Cohort Study had all the necessary data.

Using the wealth of data from the Rakai study, Polis found that hormonal contraception appears to be safe for use in HIV-infected women; HIV did not progress any faster in women who used the hormonal methods than it did in those who use other methods.

This finding provides good news on two fronts: family planning and HIV prevention. On the first front, HIV-infected women who wish to prevent pregnancies may now be soundly counseled that hormonal contraceptives are safe to use. The second ramification is that, in preventing unintended pregnancies in HIV-infected women, there are fewer babies born at risk of acquiring HIV through exposure in utero or through breastmilk—and thus HIV prevention is increased. Bolstering that good news is the fact that hormonal contraception as a means of preventing the spread of HIV is significantly more cost-effective than the HIV prevention strategy that involves providing pregnant, HIV-infected women with antiretroviral therapy prophylaxis.

In this case, contraception meets not only family planning needs, but supports HIV prevention efforts.

Written by C. Grillo | JHSPH

November 17, 2009 at 8:29 pm

Unsafe Abortions in Tanzania

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Alison Norris advises a woman in Zanzibar.

Unmet contraceptive need in the country of Tanzania is high. According to Demographic and Health Surveys data, only 24 percent of married couples use a modern method of contraception, and 22 percent have unmet need. In Zanzibar, a semi-autonomous string of islands in Tanzania, the unmet need is more extreme.

One result of the high unmet need and unwanted pregnancies in Zanzibar is a high prevalence of unsafe abortion, which can lead to infection, to hemorrhage, or to infertility. In Zanzibar, as in many other places around the world, unsafe abortions are induced either by oral ingestion of herbs or other substances, or by vaginal insertion of a substance into the cervix or the uterus. Such substances include herbs, chloroquine, laundry detergent and ashes. Not surprisingly, the highest rate of complication occurs among those who induce abortion by insertion.

Alison Norris, MD, PhD, a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health, is preparing a study to look into the causes and effects of unsafe abortion in Zanzibar. In a talk on Tuesday, she cited two broad reasons why contraception prevalence—and thus, unwanted pregnancy—is so low in Tanzania: religion and culture. In Tanzania, which is predominantly Muslim, the generally held belief is that God decides if you have a child or not. According to Norris, the cultural challenges to contraception are many: husbands worry about the fidelity of their wives if using contraceptives; mothers-in-law harass their daughters-in-law to become pregnant; and the widely held belief is that if you don’t have money, your wealth is in your children.

Written by C. Grillo | JHSPH

November 17, 2009 at 8:13 pm

Posted in Nov. 17 Talks

Labor Pains: Wives Want Their Husbands There

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Presenting findings from a study authored by Oladosu Ojengbede (University College Hospital, Ibadan, Nigeria), Stan Becker (Johns Hopkins Bloomberg School of Public Health), and others, Stella Okonkwo addressed the role of husbands during their wives’ delivery of their children.

According to Okonkwo, an obstetrician-gynecologist with University College Hospital, Ibadan, there is evidence that Nigerian women desire their husbands’ support during childbirth. The husband’s support and presence, data shows, are associated with better outcomes in the infant’s health.

In a study among Nigerian women and men, data showed that women whose husbands were present during childbirth were more likely to use contraceptives than those whose husbands were not present. Also, among the group whose husbands supported their wives during childbirth, the husbands were more likely to initiate the use of modern contraceptives among their wives.

Written by C. Grillo | JHSPH

November 17, 2009 at 7:54 pm

Why Men Don’t Take Part in Family Planning

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The man’s role in family planning is a popular topic, and many researchers believe that by increasing men’s involvement, contraceptive use will soar.

Macellina Yinyinade Ijadunola, of the Department of Community Health, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, presented findings from a recent study of male involvement. Among study participants in Ile-Ife, the data showed that 89 percent of men approved their wives use of family planning methods. But the question remained: Why do men themselves not participate in family planning?

Surveying family planning service providers in Ile-Ife, Ijadunola and colleagues found that the top three reasons—in the opinion of the providers—for men not participating were as follows: male participation in family planning goes against cultural norms; family planning is the women’s business; or religion dictates against it.

In conclusion, Ijadunola said, men in the study have the knowledge, but do not participate. “We need male service providers,” she said, “improved social marketing, and male-targeted information in the mass media.

Written by C. Grillo | JHSPH

November 17, 2009 at 7:43 pm