Advances in Reproductive Health: Strengthening Reproductive Health Care for Adolescent Girls and Women in Low-Resource Settings

Publication date: 2016

R E P R O D U C T I V E H E A L T H Advances in reproductive health Good reproductive health is a basic human right, but adolescent girls and women around the world—especially in low-resource settings—struggle to find affordable and effective products, services, and information for their needs. PATH works to improve technologies and strengthen services by focusing on specific needs for different stages in women’s lives. This means, for example, ensuring availability of youth-friendly services for adolescents, contraceptive choices for women in their main child-bearing years, and information and services for breast and cervical cancer for mid-adult women. Our first task is to produce evidence on the best technologies and program approaches for women’s needs, with a focus on engaging the user for input as we conduct our research. Many women today want self-administered testing and products, such as the new contraceptive presentation for self-injection that is discussed below. Not only does this approach give people more control, but it frees up health care workers—who remain in short supply in regions such as sub-Saharan Africa—for more acute needs. We use the evidence we generate to inform ministries of health, international agencies, and donors about practical, acceptable products, and to advocate for policy change where it is needed. Some of our projects are highlighted below. ADOLESCENT WOMEN: SUPPORTING MENSTRUAL HEALTH In many low-resource settings, the culture of silence and taboo that surrounds menstruation is compounded by a lack of affordable and appropriate menstrual care products— creating an especially difficult situation for adolescent women just starting this phase of their lives. Global research shows that when girls have their periods, they frequently miss school. Sanitary pads are often so expensive that women resort to using old rags, strips of mattress, or plant material, which can lead to bacterial vaginosis and further health problems. PATH is exploring a reusable and leak- resistant underwear base for a sanitary pad; conducting menstrual cup research; and promoting openness in discussing menstrual health in India and Kenya. CHILD-BEARING YEARS: MEETING WOMEN’S CONTRACEPTIVE NEEDS Sayana Press. Injectable contraceptives are the most popular method among women in sub-Saharan Africa—they offer safe and effective protection, convenience, and privacy—but most injections are given at clinics. Sayana® Press is a small plastic squeezable bubble prefilled with contraceptive and attached to a short needle for injection just under the skin, so administration by health care workers with minimal training is feasible. Since 2014, PATH has coordinated a country-led introduction of Sayana Press in Burkina Faso, Niger, Senegal, and Uganda, making this client-friendly method available not only in clinics, but in some areas, via community-based health providers. In 2015, Sayana Press received regulatory approval for self-injection, and PATH has started research in Senegal and Uganda to learn how to support women to self-inject safely and effectively. Self-injection could improve access to contraceptives and increase women’s control of their health, especially for adolescent women. MID-ADULT WOMEN: IMPROVING EARLY DETECTION AND TREATMENT OF WOMEN’S CANCERS Cervical cancer. In 2012, PATH completed a multi-year HPV vaccination project in Africa, Asia, and Latin America that generated data on the best ways to achieve high coverage of girls 9 to 13 years old, for whom the vaccine is recommended. Older women need access to screening— either by a relatively simple visual inspection method or by HPV DNA testing. PATH and partners have worked to develop lower-cost DNA tests and bring this testing to several Central American countries, and to support pilot introduction projects in three East African countries. We also are working on improvements to two low-cost and simple treatments for precancerous lesions: cryotherapy (to freeze affected tissue) and thermal coagulation (to destroy tissue by heat). Breast cancer. Breast cancer is now the most common cancer in women worldwide, causing more than half a million deaths every year. In Peru, PATH and the national government collaborate in a program to develop a AR E A O F FO C U S Strengthening reproductive health care for adolescent girls and women in low-resource settings Developing technologies and supplies for low-income settings resource settings September 2016 community-based model of breast health care that trains health promoters to encourage women of appropriate ages to seek breast cancer screening and all women to come promptly if symptoms occur; trains clinical providers how to conduct clinical breast exams, and trains doctors how to do breast ultrasound and fine-needle aspiration biopsy. The success of the model over several years of testing demonstrates its readiness for expansion and growth in Peru and for adaptation to other low-resource settings. Initial formative research is starting in Uganda to lay the groundwork for a similar program. Program approaches to ensure that technologies and services are available when and where needed ADVOCATING FOR PHARMACY-BASED SERVICES Commercial pharmacies are often the only accessible points for health care in low-resource communities. Partnering with other NGOs, we are working to improve policy environments so that private pharmacy and drug shop workers will be integrated into health systems and trained to deliver high-quality basic health services and products. PATH also has worked directly with health systems in building provider capacity in Cambodia, Kenya, Nicaragua, Ukraine, and Vietnam, with special emphasis on youth- friendly pharmacies. Youth-oriented services are those that offer convenient locations and hours, affordable products, and providers who are non-judgmental toward youth. ENSURING A CONSISTENT SUPPLY OF PRODUCTS The Reproductive Health Supplies Coalition (RHSC) works to ensure that women and men around the world can obtain and use safe, affordable reproductive health supplies. As Secretariat of the RHSC, PATH provides global leadership in making these essential items available in developing countries. Activities of the RHSC include work to reduce or eliminate stockouts of supplies that can disrupt family planning. PROMOTING A TOTAL MARKET APPROACH FOR CONTRACEPTIVE NEEDS Reduced aid from international donors means that ministries of health in developing countries are struggling to meet the contraceptive needs of their family planning programs. A total market approach (TMA) is government-led coordination of a full range of service providers—public sector, nongovernmental and faith-based organizations, and the commercial sector—to meet the needs of diverse population segments. This approach allows donor funds to support clients most in need, while other mechanisms meet the needs of more prosperous consumers. The private sector is well positioned to bring new and innovative contraceptive technologies to the market, create demand, and, ultimately, increase choice for women. PATH is currently supporting the Democratic Republic of Congo and Myanmar, and has assisted Vietnam and Nicaragua, with TMA planning. We also have conducted joint workshops on TMA with UNFPA in Eastern Europe and Central Asia. OUR MISSION Women’s primary reproductive health concerns vary throughout their lives, from puberty to post-menopausal stages—although of course, there is overlap, with menstrual products and contraceptives needed for many years, and cancer screening starting before menopause. PATH designs and evaluates low-cost, high-impact solutions for women in all life stages in low-resource settings worldwide, working in collaboration with users on effective designs and with national health systems on the most feasible program approaches. Through our focus on robust, affordable products and implementation of workable programs, we bring good health care closer to women in their communities. RESOURCES FOR PATH’S WORK IN REPRODUCTIVE HEALTH PATH’s reproductive health global program: http://sites.path.org/rh/ Planning and evaluation tools for cervical cancer prevention: http://www.rho.org/HPV-practical-experience.htm Protecting women from cervical cancer: http://sites.path.org/rh/recent- reproductive-health-projects/cervical-cancer/ Improving breast health in low-and middle-income countries: http://sites.path.org/rh/recent-reproductive-health-projects/improving- breast-health/ Sayana Press: a contraceptive within reach: http://sites.path.org/rh/recent-reproductive-health-projects/sayanapress/ SILCS diaphragm: http://sites.path.org/rhtech/silcs-diaphragm/ Women’s condom: http://sites.path.org/rhtech/womans-condom/ Reproductive Health Supplies Coalition: http://www.rhsupplies.org For more information about PATH’s Reproductive Health Global Program, contact info@path.org.

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