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Emergency Contraception : Global Activity

Strategic approach to introduction of fertility regulation technologies
– Dr Peter Fajans, WHO, Geneva

A strategic approach is essential for the success of any community-based programme. For effective introduction of fertility regulation technologies, strategies must be evolved taking into account the user perspectives, the available technology, and the service and delivery system with an in-built quality assurance (Fig. 1).

The different stages for which strategies must be formulated include:

Stage I - Assessment

Stage II - Testing of interventions

Stage III - Scaling up

The questions that need to be addressed before the introduction of a new contraceptive technology are:

Is there a need for the introduction of a new method?

Does an existing method which is poorly- provided or under-utilized need to be re-introduced?

Removal of an unsafe or inappropriate method.

Answers to these questions are important for improving the quality of care.

In Stage I, the strategies for assessment must focus on the users' needs and perspectives in the existing social, cultural, economic and political context. Any possible links to related reproductive health issues must be explored and combined to make the new method more attractive and acceptable. A cafeteria approach or method-mix must be offered. The capacity of the existing service- providers must be examined with an emphasis on quality of care. The background knowledge must then be utilized to plan workshops involving multiple stakeholders to ensure viability and success of the programme. Links with other reproductive health issues need to be explored. A qualitative field methodology and country ownership of the process and result is important.

In Stage II, action research should be undertaken to evaluate the service delivery system and user profile. Introductory trials should be launched in a limited field area and the management problems researched.

In Stage III, scaling up involves that these research findings are disseminated, and strategic plans for expansion developed based on the research findings. The service delivery system should be scaled up to meet the requirements of the programme, and the generation of additional delivery system explored.

A phasic introduction as planned by WHO to broaden contraception choice with improved quality of care is depicted in fig.2.

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