Delivering high-quality family planning services in crisis-affected settings I: program implementation

Area of Science:

• Public Health
• International Health
• Reproductive Health

Background:

• Conflict disproportionately affects women of reproductive age, with 43 million experiencing its effects in 2012.
• Access to sexual and reproductive health services, including family planning, is a recognized right for displaced populations, yet services remain inadequate.
• The Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) initiative addresses this gap in crisis-affected settings.

Purpose of the Study:

• To describe lessons learned from implementing the SAFPAC initiative over 2.5 years.
• To highlight strategies for delivering family planning services in challenging, crisis-affected environments.
• To assess the effectiveness of interventions in increasing contraceptive uptake among women in conflict zones.

Main Methods:

• The SAFPAC initiative employed four core interventions: competency-based provider training, improved supply chain management, regular supervision, and community mobilization.
• A "pull" system for commodity management was instituted, allowing facilities to reorder based on consumption.
• In-country training centers were established to build sustainable capacity for provider training and supervision.

Main Results:

• The initiative reached 52,616 new users of modern contraceptive methods across five countries (Chad, DRC, Djibouti, Mali, Pakistan) within a catchment population of 698,053 women.
• Sixty-one percent of new users opted for long-acting reversible contraceptives (LARCs), such as implants or intrauterine devices.
• Monthly supervision using checklists improved service quality, particularly infection prevention and stock management.

Conclusions:

• Despite significant constraints in crisis-affected countries, best-practice approaches can successfully extend access to a range of contraceptive methods, including LARCs.
• Building local capacity for training and supervision is key to sustaining service delivery.
• Culturally appropriate community mobilization is integral to meeting unmet family planning needs in emergencies.