In July 2015, World Health Organization shared an update on progress in achieving its commitments to FP2020.
Expanding choice and method mix through contraceptive research and development and assessment of the safety and efficacy of new and existing methods: The WHO supported a clinical study that assesses the effectiveness of the three-year one rod etonogestrel (ENG) and the five-year two rod levonorgestrel (LNG) releasing contraceptive implants. At three years of follow-up, the trial found that annual cumulative pregnancy rate was very low and similar between both implant groups with a three-year cumulative rate of 0.4 per 100 (95% confidence interval [CI] 0.2-1.0) for both ENG- and LNG-implants users. No additional pregnancy was recorded beyond three years up to five years of follow up in 1-rod ENG and the 2-rod LNG, indicating the effectiveness of implants up to five years; including Implanon (1-rod ENG) which is currently recommended for three years of use. The results indicating that both the one rod etonogestrel (ENG) and the two rod levonorgestrel (LNG) can be effectively used for 5 years have been submitted for publication.
One of the key studies supported by WHO on safety of contraception is the Evidence for Contraceptive options and HIV Outcomes (ECHO) Trial a multi-center study designed to compare the risks of HIV acquisition between women randomized to DMPA, levonorgestrel (LNG) implant, and copper Intra-Uterine Devices (IUDs). The study is set to be initiated in 11 sites in four South and East African countries in collaboration with Family Health International 360, Wits Reproductive Health and HIV Institute and University of Washington.
Scaling up the availability of high-quality contraceptive commodities through product prequalification and Expert Review Panel (ERP) fast track mechanisms: In 2015, WHO approved the addition of three new methods in the latest edition of the WHO Essential medicines list (EML), 2015: the Levonorgestrel intra-uterine system, Progesterone vaginal ring (for use in women actively breastfeeding at least 4 times a day) and the etonorgestrel releasing hormonal contraceptive implant. As a member of the Technical Reference Team on Reproductive Health/Contraceptives within the UN Commission on Life Saving Commodities, WHO promoted access to under-utilized commodities. For contraception, this includes Levonorgestrel as emergency contraception, hormonal contraceptive implants, and the female condom. Milestones achieved include, the generation of best-practice tools for advocacy, quantification, demand generation, supply chain and provider training; and several product innovations. Slower progress was evident around regulatory harmonization and quality assurance.
Synthesizing and disseminating evidence on effective family planning delivery models and actions to inform policies, address barriers and strengthen programs: WHO in collaboration with the United States Agency for International Development (USAID) convened a technical consultation in January 2015 to discuss the implications of contraceptive classification, existing approaches of contraceptive classification, measurement of contraceptive use and proposed revisions to existing contraceptive classification system. The consultation identified the need to consistently classify Modern methods such as Lactational Amennorrhea Method (LAM) and the Standard Days Method (SDM), and to accurately report on users of emergency contraception.
WHO has published the following documents/articles to guide policy development and for research prioritization:
- Workforce interventions to improve access to emergency contraception pills: a systematic review of current evidence in low- and middle-income countries and recommendations for improving performance.
- Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries
- A global research agenda for family planning: results of an exercise for setting research priorities
WHO serves as the secretariat of the Implementing Best Practices Consortium, which is made of 44 international reproductive health organizations. The main purpose of the consortium is to scale-up effective reproductive health practices. Key activities that support our commitments to FP2020, include the IBP knowledge Gateway https://knowledge-gateway.org/, a virtual platform that hosts a global community of over 60,000 reproductive health professionals where new research, tools and approaches in RH/FP as well as communities of practice addressing key issues in RH/FP are shared.
At the global level, IBP organized 28 sessions at the ICFP/Addis Conference in 2013 focused on overcoming obstacles to scaling up effective practices in FP and disseminating tools, guidelines, and approaches to knowledge sharing. At the regional level, WHO/IBP has supported West Africa Health Organization (WAHO) since 2013 to develop an approach to documenting effective practices in RH/FP and organizing a Forum of Good Practices that took place in Ouagadougou in July, 2015 and hosted over 300 participants from their 15 member states. IBP’s June, 2015 semi-annual meeting held in Addis Ababa, hosted over 200 participants from East and Southern Africa to share effective practices, tools and approaches for documenting and scaling up RH/FP practices in the region. At country level numerous countries, such as Zambia, Burkina Faso, Zimbabwe, Togo, Chad and Democratic Republic of Congo (DRC) are using tools and approaches introduced by WHO and IBP on the documentation and scale-up of effective practices in RH/FP.
Working with countries with the highest levels of unmet needs to examine inequalities, vulnerabilities and reasons for unmet need, in the context of the Commission on Information and Accountability for Women’s and Children’s Health: WHO is undertaking several activities to address unmet needs in family planning/contraception using strategies such as community participation, leveraging missed-opportunities and focusing on vulnerable groups.
- The UPTAKE Project is a context-specific health sector and community-based participatory approach, to increase met needs for contraception, in a human rights framework. The project aims to increase met need for Family Planning/Contraception through the development, implementation and testing of an intervention involving community and health care provider participation within a human rights framework. This multi-country study is a complex designed intervention to increase the participation of the community and health care providers in the provision of family planning and contraceptives. The Project uses a Theory of Change framework to define the pathway to the desired overall outcome.
- The strengthening Post-Partum Family Planning Operations Research Project focuses on strengthening existing Post-Partum Family Planning (PPFP) service delivery in countries in order to better meet the needs of women during the post-partum period. The study is taking place in DRC and Burkina Faso with results being applicable to numerous countries in the West Africa region and beyond. The study is a complex intervention, using a mixed method approach including qualitative and quantitative methods.
- Women living with HIV face many challenges in accessing contraception and WHO has identified the need to strengthen HIV, sexual and reproductive health and contraceptive linkages. WHO has published guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings.
- WHO is also conducting research in Multipurpose Prevention Technologies (MPTs) to provide women and young girls with more choices for their sexual and reproductive health needs. Information on these activities can be accessed at http://www.who.int/reproductivehealth/topics/linkages/mpts/en/.
- The Discordant Couples Project is an ongoing research project to understand the family planning needs of HIV – discordant couples in urban Kenya.
- In 2013, WHO published a resource on programming strategies in post-partum family planning (PPFP) to guide the designing interventions to integrate postpartum family planning into national and subnational strategies for program planners and managers: http://www.who.int/reproductivehealth/publications/family_planning/ppfp_…. This guide was extensively used by select countries and key international stakeholders in, a global, action-oriented meeting, titled Accelerating Access to PPFP in Sub-Saharan Africa and Asia. Following this meeting, WHO is supporting 10 African countries develop and implement plans to accelerate PPFP. A key upcoming milestone with the support of the Bill and Melinda Gates Foundation is the launch of the postpartum family planning compendium that will support providers and clients in expanding choice and access to contraception.
- In 2014, WHO published a landmark guideline called, “Ensuring human rights in the provision of contraceptive information and services.” The guideline is the first authoritative, evidence-based tool that provides recommendations for policies and programs as to how they can ensure that human rights are respected, protected and fulfilled, while services are scaled up to reduce unmet need for contraception. Both health data and international human rights laws and treaties were incorporated into the guidance. This guidance is complementary to existing WHO recommendations for sexual and reproductive health programs, including guidance on family planning, maternal and newborn health, safe abortion, and core competencies for primary health care.
- A key upcoming milestone with the support of the Bill and Melinda Gates Foundation is the launch of two tools, based on the principles and standards laid out in the WHO Guidelines on human rights and contraceptive services, 1) a set of quantitative indicators for monitoring the promotion or violation of rights in health programs; 2) an implementation tool for facilitating the incorporation of the guideline recommendations were developed and published in 2015. In June 2015, the World Health Organization (WHO) released its Medical eligibility criteria for contraceptive use, Fifth edition (or MEC) which contains the latest recommendations on contraceptive eligibility for women and men with various medical conditions and personal characteristics. To compliment this release, the 2015 edition of the MEC Wheel-a tool that allows providers to more easily locate the information and recommendations for contraceptive methods was released. The MEC Guideline and Wheel have been introduced in several international professional conferences and family planning/contraception consultations. Each of these events enabled stakeholders and professional groups to learn about the new recommendations and to become familiar with the 2015 MEC Wheel. As a result of these opportunities, multiple requests (for example, Lao PDR and the Solomon Islands seek to integrate the newly relaxed recommendations into the midwifery services provided during the immediate postpartum period). WHO has provided the revised MEC to Ministries of Health in several countries (e.g., Mexico and Iran); in turn these countries have initiated revisions of their national contraceptive policies.
WHO also contributes to and promotes the online Family Planning Training Resource Package which provides training modules on Medical Eligibility Criteria Family Planning wheel and related tools and guidelines. The package includes training objectives, session plans, facilitators’ guides, handouts, presentations, role play sessions, and training evaluation tools intended to provide easy access to updated, evidence based instructional materials on contraceptive methods, to improve the quality of training of providers. The TRP has been presented in large conferences and fora Orientation and training workshops on the TRP were conducted for more than 30 countries in Africa and Asia over the last few years.
