Urban Family Planning in Sub-Saharan Africa: an Illustration of the Cross-sectoral Challenges of Urban Health.

The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural-urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts but also identify some points of connection which can be built upon. Differing historical, political, and policy landscapes means that entry points to promote urban family planning have to be tailored to the context. Such entry points can include infant and child health, female education and employment, and urban poverty reduction. Successful cross-sectoral advocacy for urban family planning requires not just solid evidence, but also internal consensus and external advocacy: FP actors must consensually frame the issue per local preoccupations, and then communicate the resulting key messages in concerted and targeted fashion. More broadly, success also requires that the environment be made conducive to cross-sectoral action, for example through clear requirements in the planning processes' guidelines, structures with focal persons across sectors, and accountability for stakeholders who must make cross-sectoral action a reality.

Policy climate, scholarship, and provision of emergency contraception at affiliates of the International Planned Parenthood Federation in Latin America and the Caribbean.

Emergency contraception (EC) has great potential to decrease the incidence and resulting consequences of unwanted pregnancy, including unsafe abortion. We conducted this study to understand EC practices in Latin America and the Caribbean (LAC). We contacted 43 International Planned Parenthood Federation affiliates in LAC to interview them about EC availability. We collected family planning norms and researched registered EC products in LAC. We searched English- and Spanish-language sources to compile EC literature reviews. Thirty-seven affiliates (86%) responded to the survey, and 62% offer EC. Central and South American affiliates are more likely to offer EC than are Caribbean affiliates. Of those offering EC, 96% offer cut-up packets of oral contraceptives, whereas six affiliates offer dedicated products. Of those not offering EC, 79% believe it constitutes abortion. EC availability and support for the method appear to be increasing in LAC, and clearer distinctions between EC and abortion in medical and policy guidelines should increase acceptance further.

Transforming family planning services in the Latin American and Caribbean region.

The 1994 International Conference on Population and Development held in Cairo has generated widespread commitment to changing family planning programs from categorical and medically focused service organizations to reproductive health initiatives that embrace a wide range of social and human services. This article uses qualitative data analysis to review the experience of nine family planning association projects in the Latin American and Caribbean region that have made a successful organizational transition from services focused on family planning to a gender-based and sexual health approach. A conceptual framework is proposed, including factors external to the organization. Factors that can promote a pilot intervention's becoming fully institutionalized include: the need for commitment from high-level staff and members of the board of directors, the creation of partnerships with other agencies, and an emphasis on monitoring and evaluation. Lessons from this experience and their potential relevance to other settings are reviewed and discussed.