Se-p Orbitals Induced "Strong d-d Orbitals Interaction" Enable High Reversibility of Se-Rich ZnSe/MnSe@C Electrode as Excellent Host for Sodium-Ion Storage.

The heterostructure of transition-metal chalcogenides is a promising approach to boost alkali ion storage due to fast charge kinetics and reduction of activation energy. However, cycling performance is a paramount challenge that is suffering from poor reversibility. Herein, it is reported that Se-rich particles can chemically interact with local hexagonal ZnSe/MnSe@C heterostructure environment, leading to effective ions insertion/extraction, enabling high reversibility. Enlightened by theoretical understanding, Se-rich particles endow high intrinsic conductivities in term of low energy barriers (1.32 eV) compared with those without Se-rich particles (1.50 eV) toward the sodiation process. Moreover, p orbitals of Se-rich particles may actively participate and further increase the electronegativity that pushes the Mn d orbitals (dxy and dx2-y2) and donate their electrons to dxz and dyz orbitals, manifesting strong d-d orbitals interaction between ZnSe and MnSe. Such fundamental interaction will adopt a well-stable conducive electronic bridge, eventually, charges are easily transferred from ZnSe to MnSe in the heterostructure during sodiation/desodiation. Therefore, the optimized Se-rich ZnSe/MnSe@C electrode delivered high capacity of 576 mAh g-1 at 0.1 A g-1 after 100 cycles and 384 mAh g-1 at 1 A g-1 after 2500 cycles, respectively. In situ and ex situ measurements further indicate the integrity and reversibility of the electrode materials upon charging/discharging.

Assessing the impact of contraceptive use on mental health among women of reproductive age - a systematic review.

BACKGROUND: Contraceptive use is the principal method by which women avoid unintended pregnancy. An unintended pregnancy can induce long-term distress related to the medical, emotional, and social consequences of carrying that pregnancy to term. OBJECTIVES: This review investigates the effects of modern contraception techniques such as birth control pills, long-acting reversible contraceptives (e.g., intrauterine devices, implants), and condoms on mental health status. METHODS: We searched multiple databases from inception until February 2022, with no geographical boundaries. RCTs underwent a quality assessment using the GRADE approach while the quality of observational studies was assessed using the Downs and Black scoring system. Data were analyzed through meta-analysis and relative risk and mean difference were calculated and forest plots were created for each outcome when two or more data points were eligible for analysis. MAIN RESULTS: The total number of included studies was 43. In women without previous mental disorders, both RCTs (3 studies, SMD 0.18, 95% CI [0.02, 0.34], high quality of evidence) and cohort studies (RR 1.04 95% CI [1.03, 1.04]) detected a slight increase in the risk of depression development. In women with previous mental disorders, both RCTs (9 studies, SMD - 0.15, 95% CI [-0.30, -0.00], high quality of evidence) and cohort studies (SMD - 0.26, 95% CI [-0.37, -0.15]) detected slight protective effects of depression development. It was also noticed that HC demonstrated protective effects for anxiety in both groups (SMD - 0.20, 95% CI [-0.40, -0.01]). CONCLUSIONS: Among women with pre-existing mental disorders who use hormonal contraceptives, we reported protective association with decreased depressive symptoms. However, the study also draws attention to some potential negative effects, including an increase in the risk of depression and antidepressant use among contraceptive users, a risk that is higher among women who use the hormonal IUD, implant, or patch/ring methods. Providers should select contraceptive methods taking individual aspects into account to maximize benefits and minimize risks.

Assessing the impact of hormonal contraceptive use on menstrual health among women of reproductive age - a systematic review.

BACKGROUND: Contraceptive methods are well-established in their ability to prevent pregnancy and increase individual agency in childbearing. Evidence suggests that contraceptives can also be used to treat adverse conditions associated with menstruation, including abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders.This review investigates the effects of contraceptive techniques such as contraceptive pills, and long-acting reversible contraceptives (e.g. intrauterine devices, implants) on menstrual morbidity. METHODS: Over ten databases with no geographical boundaries were searched from inception until October 2023. Study designs were one of the following types to be included: parallel or cluster randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies, cohort or longitudinal analyses, regression discontinuity designs, and case-control studies. Ten team members screened the papers in pairs with a Kappa score of more than 7, and Covidence was used. Conflicts were resolved by discussion, and the full papers were divided among the reviewers to extract the data from eligible studies. RESULTS: Hormonal contraceptives are considered a well-tolerated, non-invasive, and clinically effective treatment for abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders. Our studies investigating quality of life or well-being in women with heavy menstrual bleeding, endometriosis, or uterine fibroids have found improvements in all dimensions assessed. CONCLUSIONS: Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids.

Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids. Findings can inform clinical practice and policy decisions to ensure that women have access to safe and effective contraceptive options that promote both reproductive and non-reproductive health.

Exploring the pH-Responsive Interaction of ß-Blocker Drug Propranolol with Biomimetic Micellar Media: Fluorescence and Electronic Absorption Studies.

Interaction of neutral and charged lipophilic beta-blocker drug, propranolol (PPL) with biomimicking nanocavities formed by micelles bearing same and opposite charges namely, cationic cetyltrimethylammonium bromide (CTAB), a surface-active ionic liquid 1-hexadecyl-3-methylimidazolium chloride (HDMIC) and anionic sodium dodecyl sulphate (SDS) have been investigated using fluorescence and absorption spectroscopic techniques. Binding of PPL to SDS at pH < pKa is characterised by biphasic interactions with decrease in fluorescence intensity at lower concentrations and subsequent increase post micellization. All the surfactants show significant interactions with the neutral drug molecule at pH > pKa, which is evident from the strongest binding constant ([Formula: see text]) values at pH 10.4. Results of quenching studies indicate that the location of drug molecule is determined by its charge, which is influenced by both pH and charge on micelle surface. For PPL-CTAB and PPL-HDMIC systems, quenching was strongest at pH 10.4, moderate at pH 7.4 and was absent at pH 3.5. However, the PPL-SDS system displayed similar [Formula: see text] values at all pH conditions, suggesting that the probe is at the same position regardless of pH. Non-covalent interactions, which play crucial role in biological systems, are similarly the primary driving force governing the interaction between PPL and surfactant micelles.

A computer aided drug discovery based discovery of lead-like compounds against KDM5A for cancers using pharmacophore modeling and high-throughput virtual screening.

KDM5A over-expression mediates cancer cell proliferation and promotes resistance toward chemotherapy through epigenetic modifications. As its complete mechanism of action is still unknown, there is no KDM5A specific drug available at clinical level. In the current study, lead compounds for KDM5A were determined through pharmacophore modeling and high-throughput virtual screening from Asinex libraries containing 0.5 million compounds. These virtual hits were further evaluated and filtered for ADMET properties. Finally, 726 compounds were used for docking analysis against KDM5A. On the basis of docking score, 10 top-ranked compounds were selected and further evaluated for non-central nervous system (CNS) and CNS drug-like properties. Among these compounds, N-{[(7-Methyl-4-oxo-1,2,3,4-tetrahydrocyclopenta [c] chromen-9-yl) oxy]acetyl}-l-phenylalanine (G-score: -11.363 kcal/mol) was estimated to exhibit non-CNS properties while 2-(3,4-Dimethoxy-phenyl)-7-methoxy-chromen-4-one (G-score: -7.977 kcal/mol) was evaluated as CNS compound. Docked complexes of both compounds were finally selected for molecular dynamic simulation to examine the stability. This study concluded that both these compounds can serve as lead compounds in the quest of finding therapeutic agents against KDM5A associated cancers.

Potential of LARC to recover loss in satisfied demand for modern contraception after the COVID-19 pandemic: a case scenario analysis of Brazil and Mexico.

Objectives: To estimate inequalities in demand for family planning satisfied with modern methods among women in Latin America and the Caribbean, with an emphasis on Brazil and Mexico, and to calculate the scenario for recovery of modern contraceptive coverage by expanding access to long-acting contraceptives (LARC) after the COVID-19 pandemic. Methods: National health surveys from 2006 to 2018 were used to estimate the demand for family planning satisfied with modern methods and how it was affected by the COVID-19 pandemic. The scenario included three variables: coverage, health outcomes, and costs. Considering coverage, United Nations Population Fund data were used to estimate the impact of COVID-19 on access to contraception in Latin America and the Caribbean. Health outcomes were assessed with the Impact 2 tool. Direct investment was used to evaluate cost-effectiveness. Results: Substantial inequalities were found in the use of modern contraceptive methods before the pandemic. We showed the potential cost-effectiveness of avoiding maternal deaths by introducing LARCs. Conclusions: In the scenario predicted for Brazil and Mexico, the costs of modern family planning and averted disability-adjusted life years are modest. Governments in Latin America and the Caribbean should consider promoting LARCs as a highly efficient and cost-effective intervention.

Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan.

INTRODUCTION: Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. METHODS: In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts. RESULTS: Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women's experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method's use. CONCLUSION: This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

Accessibility and uptake of modern contraceptive methods in Pakistan - a critical view on what works?

BACKGROUND: In Pakistan, there is a clear imbalance between the population's needs and available resources to cater for spacing and limiting childbirth as desired by couples. More than two-thirds (70%) of the Pakistani population are now paying out-of-pocket for overall health costs. Public sector in South Asia is the main player in service provision, Pakistan, however, is unique where private sector is more significant a player in the provision of Family Planning services. The increasing reliance on the private sector is particularly prominent in rural areas where more than 30% of public sector-owned first-level care facilities are located. This critical review is guided by the aim to increase access and utilization of modern contraceptives in the underserved Pakistan. The research question explores the effects of multi-pronged health financing model "using vouchers" for increase in contraceptive access and uptake among married women in rural Pakistan. METHODS: Keeping in view on paucity of literature, this review comprised studies that were published inclusive and after 2000 on implementation research on family planning. The international scientific databases searched included PubMed, SCOPUS, and MEDLINE until December 2016. Related articles were found using key terms and based on a review of the titles and abstracts of the published papers, a total of eight published studies met the criteria and were included for this review. RESULTS: This critical review of key private sector intervention demonstrated that the use of multi-pronged health financing mechanisms targeting underserved communities such as 1) using demand-side free vouchers complemented by mid-level social franchise providers along with community health worker support to connect clients with facility and 2) using public sector trained community midwives and engaging a dedicated community health worker with them to generate demand and bridge the gap between clients with the local facility (financing CMW trainings and CHW salaries; and 3) expanding outreach services to reach out to underserved communities (financing free services) - has a positive and favourable impact. The findings show that free vouchers used alongside social franchising (multi-pronged health financing model) was able to increase the overall contraceptive uptake and also increased method specific uptake mainly for intrauterine device (IUD) and condoms in the intervention group in three different studies. Additionally, there was a favourable impact on IUD discontinuation rates (which is significantly found lower than the national average) and improved method switching during intervention and in the post-intervention period in the voucher based social franchising and outreach mobile services clients of four studies. CONCLUSIONS: The multi-pronged health financing mechanisms exclusive to FP not only were able to increase the uptake of modern FP services in underserved areas but also facilitated the long-term continuity of modern FP methods, while promoting method-specific switching behaviour. The models, using voucher based social franchising, community midwives coupled by CHWs, and the outreach services have a tangible effect on modern family planning uptake within communities. It has been documented that the provision of evidence-based interventions and care packages especially for the rural population reaching broad coverage (including approaches to promote post-abortion care; antenatal and postnatal care including family planning services) can contribute averting maternal, new-born and child deaths in Pakistan, and furthermore, a large proportion of stillbirths possibly could also be prevented.

Contraceptive access, choices, and discontinuation among the urban users in Karachi, Pakistan: Findings from a comparative analysis of Pakistan demographic and health survey 2012-12 and 2017-18.

OBJECTIVE: To explore and assess the contraceptive access, choices, and discontinuation among the urban users in Karachi using the last two Demographic and Health Surveys in Pakistan. METHODS: A comparative analysis of the six districts of Karachi (Urban only) using Pakistan Demographic and Health Survey 2012-13 (sample size 2324) and 2017-18 (sample size 2896) of the currently married women of reproductive age 15-49 years was designed and conducted. For the current study, we used descriptive statistics on contraceptive use, method-mix, unmet need for family planning, method-specific discontinuation, sources of modern contraceptive use by channel (public and private), and exposure to family planning messaging. RESULTS: The analysis of the PDHS indicated that the mCPR for Karachi Urban remained stagnant at 35%. However, CPR (all methods) improved from 48% to 52% mainly because of an increase in the traditional contraceptive methods. On the other hand, there was an increase in unmet need between the two DHS surveys from 13% to 16%. The possible explanation is inadequate resource allocations, affordability of the services, poor quality of care, and fear of side effects, among other factors. The supply-side situation indicates that the private sector holds a significant share of family planning service delivery. However, the decline of 15% in the current share of services from the private sector in Karachi's urban areas since 2012-13 PDHS data. The desire for pregnancy, method failure, and side effects remained three significant reasons for the method discontinuation. CONCLUSIONS: The present study reports a high unmet need for family planning and a stagnant mCPR for urban Karachi between the two demographic surveys. In addition, the data reveals private sector taking over the public sector for the delivery of modern contraceptive methods while the major reasons for method-specific discontinuation illustrates a similar trend at national and urban Karachi level.

Regulation of early endosomes across eukaryotes: Evolution and functional homology of Vps9 proteins.

Endocytosis is a crucial process in eukaryotic cells. The GTPases Rab 5, 21 and 22 that mediate endocytosis are ancient eukaryotic features and all available evidence suggests retained conserved function. In animals and fungi, these GTPases are regulated in part by proteins possessing Vps9 domains. However, the diversity, evolution and functions of Vps9 proteins beyond animals or fungi are poorly explored. Here we report a comprehensive analysis of the Vps9 family of GTPase regulators, combining molecular evolutionary data with functional characterization in the non-opisthokont model organism Trypanosoma brucei. At least 3 subfamilies, Alsin, Varp and Rabex5 + GAPVD1, are found across eukaryotes, suggesting that all are ancient features of regulation of endocytic Rab protein function. There are examples of lineage-specific Vps9 subfamily member expansions and novel domain combinations, suggesting diversity in precise regulatory mechanisms between individual lineages. Characterization of the Rabex5 + GAPVD1 and Alsin orthologues in T. brucei demonstrates that both proteins are involved in endocytosis, and that simultaneous knockdown prevents membrane recruitment of Rab5 and Rab21, indicating conservation of function. These data demonstrate that, for the Vps9-domain family at least, modulation of Rab function is mediated by evolutionarily conserved protein-protein interactions.

Modulation of ABCG2 surface expression by Rab5 and Rab21 to overcome multidrug resistance in cancer cells.

Human ABCG2 is a half transporter implicated in drug efflux and development of multidrug resistance (MDR) in cancer cells. Here we present the regulatory effects of early endocytic Rab GTPases, Rab5A and Rab21 on ABCG2.ABCG2 was stably expressed in MCF-7 cells (MCF-7/G2). Rab5A and Rab21 were manipulated in MCF-7/G2 cells by co-expression or siRNA knockdown and their effect on ABCG2-mediated drug efflux was quantified using fluorescence microscopy.The ectopically expressed ABCG2 was predominantly confined to the plasma membrane and was capable of drug efflux. Expression of constitutively active Rab5A-Q79L mutant in MCF-7/G2 cells decreased the cell surface expression of ABCG2, resulting in the reduction of ABCG2-mediated drug efflux. In contrast, expression of inactive Rab5A-S34N mutant enhanced cell surface expression of ABCG2 and drug efflux. Moreover, reduction in endogenous Rab21 levels in MCF-7/G2 cells by siRNA knockdown, increased the surface localisation of ABCG2. Consequently, efflux ability of cells increased and intracellular retention of doxorubicin and Hoechst 33342; substrates of ABCG2, decreased significantly.These findings suggest that Rab5A and Rab21 play important roles in regulating ABCG2 surface localisation and turnover and can be exploited as a potential strategy to overcome MDR in cancer cells.

Contraception and post abortion services: qualitative analysis of users' perspectives and experiences following Zika epidemic in Honduras.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy has severe consequences on the new-born. The World Health Organization declared the Zika outbreak to be a Public Health Emergency of International Concern (PHEIC) in 2016. Health facilities in the regions most affected by Zika lacked the capacity to respond to the increased demand for contraception. The objectives were to explore healthcare users' perceptions regarding contraception, Zika prevention during pregnancy and post-abortion care (PAC) services in the context of a Zika outbreak in Tegucigalpa, Honduras, and to follow these services over time. METHODS: This study was part of a broader implementation research study. We used qualitative research consistent with grounded theory approach. Semi-structured interviews and focus groups were performed with women and their partners who used contraceptive services or received PAC services. Data were collected in two stages from December 2017 to July 2018. Themes explored included contraception, Zika and PAC services. RESULTS: Participants had positive attitude towards the use of contraceptive methods and demanded more information on safety, efficacy and on side effects. Health care services were inconsistent in the provision of information on Zika and contraception services. ZIKV vector transmission was known but fewer participants were aware of risk of sexual transmission of Zika. Barriers to access healthcare services included contraceptive and PAC services included distance to healthcare facilities, disorganized admission process, long waiting times and out-of-pocket expenditure to purchase medicines. Furthermore, poor quality, mistreatment and abuse of women seeking PAC was prevalent. Some positive changes were noted over time, such as improvements in infrastructure including improved privacy and cleanliness, removal of fees, requisite to bring clean water to hospital. CONCLUSIONS: Our results highlight the challenges and areas for improvement in policy and practice related to contraceptive services and PAC in the context of ZIKV infection. Public policies to prevent epidemics should focus more on providing proper sanitation; removing barriers to access and use of effective contraception as human rights priority. Zika epidemic has highlighted weaknesses in health systems that obstruct access to and use of sexual and reproductive health services. The study results call for increased efforts to improve access, especially for women of low socio-economic status and intervene at different levels to eradicate discrimination and improve equity in the provision of health care. Qualitative methods can capture the community perspectives and can provide useful information to develop interventions to improve services.

Understanding sexual and reproductive health needs of young women living in Zika affected regions: a qualitative study in northeastern Brazil.

BACKGROUND: In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika's association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. METHODS: Individual semi-structured interviews were conducted with 22 young women, aged 14-24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. RESULTS: Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika's sexual transmission. CONCLUSIONS: The young women's knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.

Sexual and reproductive health (SRH): a key issue in the emergency response to the coronavirus disease (COVID- 19) outbreak.

The novel coronavirus disease (COVID-19) outbreak was first declared in China in December 2019, and WHO declared the pandemic on 11 March 2020. A fast-rising number of confirmed cases has been observed in all continents, with Europe at the epicentre of the outbreak at this moment.Sexual and reproductive health (SRH) and rights is a significant public health issue during the epidemics. The novel coronavirus (SARS-CoV-2) is new to humans, and only limited scientific evidence is available to identify the impact of the disease COVID-19 on SRH, including clinical presentation and outcomes of the infection during pregnancy, or for persons with STI/HIV-related immunosuppression. Beyond the clinical scope of SRH, we should not neglect the impacts at the health system level and disruptions or interruptions in regular provision of SRH services, such as pre- and postnatal checks, safe abortion, contraception, HIV/AIDS and sexually transmitted infections. Furthermore, other aspects merit attention such as the potential increase of gender-based violence and domestic abuse, and effects of stigma and discrimination associated with COVID-19 and their effects on SRH clients and health care providers. Therefore, there is an urgent need for the scientific community to generate sound clinical, epidemiological, and psycho-social behavioral links between COVID-19 and SRH and rights outcomes.

Correction to: Sexual and reproductive health (SRH): a key issue in the emergency response to the coronavirus disease (COVID- 19) outbreak.

An amendment to this paper has been published and can be accessed via the original article.

CRISPR/Cas9 engineering of ERK5 identifies its FAK/PYK2 dependent role in adhesion-mediated cell survival.

Extracellular signal-regulated kinase 5 (ERK5) is now considered a key regulator of breast cancer cell proliferation, migration and invasion. It is also implicated in growth factor induced anti-apoptotic signaling. But its contribution to adhesion-induced survival signaling is not clear. In the present study, using CRISPR/Cas9 editing, we knocked-out ERK5 expression in several cancer cell lines. Then MDA-MB 231 breast cancer cells lacking ERK5 were used to understand its role in adhesion-mediated cell viability. We demonstrated that ERK5 deficient cells exhibited reduced cell attachment to matrix proteins fibronectin and vitronectin. The adhesion ability of these cells was further reduced upon chemical inhibition of focal adhesion kinase (FAK) and proline-rich tyrosine kinase 2 (PYK2) by PF 431396. FAK/PYK2 inhibited ERK5 knock-out cells also showed markedly reduced cell-viability and increased apoptotic signaling. This was evident from the detection of cleaved PARP and caspase 9 in these cells. Thus, our data suggests a FAK/PYK2 regulated pro-survival role of ERK5 in response to cell adhesion.

'Leaving no one behind': a scoping review on the provision of sexual and reproductive health care to nomadic populations.

BACKGRUND: Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. METHODS: Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. RESULTS: Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. CONCLUSION: Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.

Expanding choice and access in contraception: an assessment of intrauterine contraception policies in low and middle-income countries.

BACKGROUND: Globally 214 million women of reproductive age in developing regions have unmet needs in modern contraceptives. Intrauterine contraception (IUC) is highly effective, has few medical contraindications, low discontinuation, and is a low cost modern contraceptive method. However, there is relatively low use of IUDs in LMICs. One reason for this may be policies that restrict IUD availability and use. This study assess national policies pertaining to IUD from a diverse set of countries. METHODS: Between December 2015 and February 2016, a 12-question survey pertaining to IUD policy was sent to WHO regional and country representatives. RESULTS: Sixty-nine surveys were used from countries through WHO regional offices. Among those surveyed, 87% (n = 60) had policies pertaining to IUD use. Among them, 84% (n = 58) reported that hormonal IUDs were available, but only 42% (n = 29) had them in the public sector. Free IUDs in the public sector were available in 75% (n = 52) of countries. For IUD promotion, 75% (n = 52) of countries reported cooperation with NGOs, and 48% (n = 33) received free devices from donors. Policy restrictions beyond the WHO guidelines existed in 15 countries and included restrictions to use for women who were nulliparous, adolescent, unmarried, or had multiple partners. CONCLUSIONS: National policy is important in facilitating modern contraceptive uptake. While many countries who responded in the survey, have policies about IUD use in place, 16% still had none on IUD. Another gap identified was low availability of hormonal IUDs, especially in the public sector. Private sector remains untapped potential in expanding method choice by making IUDs available and accessible in developing countries. Most countries do have policy in place to facilitate IUD use, though there are still gaps in the accessibility of IUDs in many countries. Lastly there is a need to revisit restrictive policies that prevent IUD use for specific populations of women for whom IUDs can be beneficial in realizing their reproductive needs.

Are family planning vouchers effective in increasing use, improving equity and reaching the underserved? An evaluation of a voucher program in Pakistan.

BACKGROUND: Low modern contraceptive prevalence rate and high unmet need in Pakistan aggravates the vulnerabilities of unintended pregnancies and births contributing to maternal morbidity and mortality. This research aims to assess the effectiveness of a free, single-purpose voucher approach in increasing the uptake, use and better targeting of modern contraceptives among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan. METHODS: A quasi-interventional study with pre- and post-phases was implemented across an intervention (Chakwal) and a control district (Bhakkar) in Punjab province (August 2012-January 2015). To detect a 15% increase in modern contraceptive prevalence rate compared to baseline, 1276 women were enrolled in each arm. Difference-in-Differences (DID) estimates are reported for key variables, and concentration curves and index are described for equity. RESULTS: Compared to baseline, awareness of contraceptives increased by 30 percentage points among population in the intervention area. Vouchers also resulted in a net increase of 16% points in current contraceptive use and 26% points in modern methods use. The underserved population demonstrated better knowledge and utilized the modern methods more than their affluent counterparts. Intervention area also reported a low method-specific discontinuation (13.7%) and high method-specific switching rates (46.6%) amongst modern contraceptive users during the past 24 months. The concentration index indicated that voucher use was more common among the poor and vouchers seem to reduce the inequality in access to modern methods across wealth quintiles. CONCLUSION: Vouchers can substantially expand contraceptive access and choice among the underserved populations. Vouchers are a good financing tool to improve equity, increase access, and quality of services for the underserved thus contributing towards achieving universal health coverage targets.

Assessment of modern contraceptives continuation, switching and discontinuation among clients in Pakistan: study protocol of 24-months post family planning voucher intervention follow up.

BACKGROUND: Pakistan has the second highest fertility rate in South Asia and its increasing population growth presents a significant challenge for country's path to progress and development. Modern contraceptive methods only account for a slow-rising 26% of use in Pakistan which is further lowest in the underserved areas (< 20%), with a high unmet need for family planning (20%). The David and Lucile Packard Foundation USA and Pakistan funded two operational research projects from 2012 to 2015, that employed a Demand-side Financing (DSF) approach testing the effectiveness of single and multi-purpose voucher schemes in increasing access and uptake of FP services and products among the women of two-lowest income quintiles in the Punjab province of Pakistan. The present paper presents a study protocol which intends to assess the longer term impact of these two voucher intervention programs among married women of reproductive age (MWRA) who received contraceptive services through vouchers. METHODS: This will be a mixed methods study using qualitative and quantitative approaches. A quantitative cross sectional survey will measure the contraceptive uptake among voucher users, included in the endline survey and to examine the attitudes and behaviour of women with respect to contraceptive continuation, switching and discontinuation 24 months post intervention in two districts of Chakwal and Faisalabad in Punjab province of Pakistan. Qualitative in-depth interviews will be conducted with FP service providers operating in intervention areas and with key policy makers in the public sector to examine and document the service provider perspective on sustainability on contraceptive practices and behaviour in the post project closure period within the intervention areas. DISCUSSION: Globally, there is almost negligible direct evidence on the assessment of longer-term impact of a demand-side financing programs using free or subsidized vouchers for family planning services especially during post-intervention period or when donor money runs out. The findings of this study will help fill the knowledge gap in the context of sustainability issues post-intervention and will provide information to policy makers to develop and plan contraceptive services in the target area to sustain the positive behaviour change in the population.