Comment: silent burden no more: a global call to action to prioritize perinatal mental health.

Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority.

Family planning methods and fertility preferences according to HIV status among women in Cameroon.

We investigated whether HIV-positive women differ from HIV-negative women in their fertility, fertility intentions, and use of family planning (FP) among 16,202 women who received services through the Cameroon Baptist Convention Health Services' Women's Health Program from 2015 to 2017. The 13% of women who were HIV-positive had similar rates of modern FP usage and unmet need compared to HIV-negative women (26% versus 29% for modern FP usage, and 20% versus 21% for unmet need). However, HIV-positive women were more likely to be satisfied with their FP method (aOR = 1.70, p < .001). There were no significant differences in usage by HIV status for most FP methods, but HIV-positive women were more likely to use condoms (aOR = 1.85, p < .01) and less likely to use IUDs (aOR = 0.77, p < .05). HIV-positive women had fewer living children and also desired fewer children (both associations significant at p < .001 in multivariate linear regression). These findings highlight low FP usage and high unmet need among all women, and the need for integrated HIV and FP services for HIV-positive women, particularly aimed at increasing use of more reliable FP methods in addition to condoms.

Increasing Family Planning Access in Kenya Through Engagement of Faith-Based Health Facilities, Religious Leaders, and Community Health Volunteers.

Health facilities managed by faith-based organizations (FBOs) are important providers of health care in Kenya but provide only a small proportion of family planning services in the country. From 2013 to 2017, the Christian Health Association of Kenya (CHAK) implemented a project with 6 FBO-managed health facilities to increase voluntary family planning services in western Kenya, in partnership with religious leaders and community health volunteers (CHVs). The project aimed to build capacity of FBO-managed health facilities, increase religious leaders' knowledge of family planning, mobilize communities, improve family planning access and referrals for services, and advocate for improved family planning commodity security from the public sector. Project impact was evaluated using facility-level service statistics, project records and reports, and feedback from religious leaders and CHVs who implemented the project. Facility service statistics showed large increases in family planning visits. Phase 1 (2013-2014) was implemented at 2 health facilities, where client visits for family planning increased sixfold (from 705 to 4,286 visits) with tenfold increases seen in client visits for pills, intrauterine devices, and implants. In Phase 2 (2015-2017), the project was expanded to an additional 4 health facilities and total client visits for family planning nearly doubled (from 7,925 to 14,832 visits). During Phase 2, new client visits for implants increased threefold, making implants the most popular family planning method. Religious leaders who implemented the project reported reaching nearly 700,000 people with family planning messages and referring more than 87,000 clients to health facilities for family planning services. The religious leaders expressed confidence in the effectiveness of the project and in their role in enhancing access to voluntary family planning. Health facilities, religious leaders, and CHVs also reported multiple challenges to implementation, including inconsistent supply of family planning commodities from county health departments. This project demonstrates the potential of FBO-managed facilities and faith leaders to increase family planning demand and service provision, as well as the importance of coordination with the public sector to ensure supply of commodities and support for FBO-managed facilities.

Advocacy for International Family Planning: What Terminology Works?

Advocating for international family planning while avoiding miscommunications with politically and religiously conservative policy makers and the public requires care and clarity with language. We find that terms such as "international family planning" are well received when the meaning is clearly explained, such as "enabling couples to determine the number and timing of pregnancies, including the voluntary use of methods for preventing pregnancy - not including abortion - harmonious with their beliefs and values". Family planning also helps reduce abortions - a powerful message for conservative policy makers and the public. We concur with Dyer et al. (2016) that the messenger is important; we find that many of the most effective advocates are religious leaders and faith-based health providers from the Global South. They know and validate the importance of family planning for improving family health and reducing abortions in their communities. "Healthy timing and spacing of pregnancy" is positive language for policy makers, especially when describing the health impact for women and children. Universal access to contraceptive services is emerging as vital for family health and also to help achieve the Sustainable Development Goals (UN 2015). Language on international family planning will evolve, and clarity of meaning will be foundational for effective advocacy.