Effects of Performance-Based Financing on Availability, Quality, and Use of Family Planning Services in the Democratic Republic of Congo: An Impact Evaluation.

Access to high-quality family planning services remains limited in many low- and middle-income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance-based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty-eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow-up data collection took place in 2021-2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand-side interventions are likely needed in a setting with very low baseline utilization.

"I probably have access, but I can't afford it": expanding definitions of affordability in access to contraceptive services among people with low income in Georgia, USA.

BACKGROUND: Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals' lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access-affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South. METHOD: Between January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access. RESULTS: Affordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A "poor fit" between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance. CONCLUSIONS: Affordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.

RU-486=Preguntas y respuestas / RU-486 Question and answer

Los fármacos con antiprogestina constituyen un nuevo método prometedor para el control de la natalidad. El RU-486, también conocido con el nombre de mifepristone, es el primer fármaco con antiprogestina disponible en el mercado. Hasta ahora se ha aprobado en Francia y China como alternativa no quirúrgica para terminar los embarazos en su etapa inicial. Siguen investigándose las distintas aplicaciones anticonceptivas del RU-486, que también parece tener varios otros usos terapéuticos. El RU-486 y otros fármacos parecidos pueden contribuir a eliminar las complicaciones relacionadas con las actuales técnicas quirúrgicas del aborto. Estos fármacos son potencialmente menos costosos y más aceptables para muchas mujeres que el aborto quirúrgico. Hoy en día, los expertos en medicina recomiendan usar el RU-486 dentro de un período de tres semanas después de producido el atraso menstrual y administrarlo junto con otro fármaco, la prostaglandina, la cual aumenta mucho su efectividad. En vista de que a veces se presentan problemas de hemorragias y abortos incompletos, el RU-486 debe tomarse bajo supervisión médica. El RU-486 podría reducir enormemente las defunciones por abortos practicados en condiciones deficientes en los países en desarrollo. Pero como este fármaco se ha convertido en objeto de considerables controversias, es probable que en muchos países su disponibilidad dependa de factores políticos

Contracepção: percepção e prática / Contraception: perception and practice

A necessidade da elaboração do presente trabalho surge da problemática vivenciada na atuação junto a clientela feminina, em uma unidade básica do serviço público de saúde. Emerge principalmente da exigência de um posicionamento frente a demanda feminina por anticoncepção. Num momento em que estava ainda presente a polêmica acerca do controle da natalidade. Termo já de tal maneira pejorativo que as ações buscando uma mudnça coletiva no comportamento no sentido de controlar a prole eram denominadas de forma mais agráveis, por exemplo, como atividades no sentido de prover a "Paternidade Responsável"...

Financiamento dos programas de planejamento familiar no Brasil: estratégias econômicas de sustentaçäo / Financing of the family planning programs in Brazil: economic strategies of support

Discorre sobre planejamento familiar no Brasil. Apresenta a evoluçäo recente da populaçäo e politicas demograficas desenvolvidas. Apresenta estimativas da oferta, demanda e custos dos serviços de planejamento familiar. Analisa a questäo do financiamento e gastos dos programas de planejamento familiar e os esforços para a diversificaçäo do custeio dos programas (NMPM)