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
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
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.