In over 30 countries throughout the world PSI empowers women and couples to lead healthier lives by providing access to innovative family planning and maternal health products and services. Every year, there are more than 60 million unintended pregnancies and more than 500,000 women die from pregnancy-related causes.

In 2008 alone, PSI prevented an estimated 3.1 million unintended pregnancies and 15,000 maternal deaths, and enabled millions of couples to plan their families.

Over the past three decades, PSI has expanded the contraceptive methods in its portfolio from male condoms and oral contraceptives to include injectable contraceptives, intrauterine contraceptive devices (IUD), emergency contraception pills, implants, female condoms, voluntary sterilization, and fertility awareness methods such as the Standard Days Method using Cyclebeads®. PSI’s RH platform has also grown to address maternal mortality through the prevention of post-partum hemorrhage and sepsis, and the prevention of unsafe abortion.

PSI employs innovative approaches to overcome significant consumer and provider-driven barriers to contraceptive use, and adapts its programs to the socio-cultural and economic environment of the target population.
Read More

PSI’s reproductive health programs:

• Contribute to expanding method choices for the targeted population;
• Develop adequate packaging, information and education materials for reproductive health products that enhance correct usage and compliance;
• Build upon local wholesale and retail infrastructure to create extensive and efficient distribution networks that make reproductive health products widely available;
• Charge affordable prices depending on the population income level and willingness to pay;
• Develop communication campaigns to educate individuals on the health and economic benefits of a given health behavior;
• Utilize community health workers to reach consumers through interpersonal communication;
• Work with local providers to expand the services and products they offer, improve the quality of their services and ensure they offer accurate information;
• Approach family planning promotion from both the supply and demand angles, informing both users and providers on family planning’s benefits, matching women’s demand for affordable services delivered by trained, high-quality service providers.
• Form private, franchised networks of providers as well as accredited netoworks of public, private and NGO providers who offer high quality family planning services.

Read More

Meeting Unmet Need for Family Planning

More than 200 million women in the developing world have an unmet need for family planning, yet do not have acces to modern contraceptives. Providing access to family planning prevents unintended, often high-risk pregnancies - those that come too early, too often or too late in life – and reduces the number of abortions, especially unsafe abortions, saving women's lives and protecting their health.

Benefits of family planning extend beyond a woman’s improved health. Spaced births and fewer pregnancies improve child survival (since infants born closely together are at considerably higher risk of dying before their first birthday). Women also have greater access to education and employment opportunities when they control their fertility, which can enhance their own and their families’ economic status.

By expanding access, ensuring affordability, and overcoming barriers, PSI is empowering women and couples to choose when and how many children they will have in their lifetime. Meeting this need is a critical part of improving the health and well being of women, families and communities.

In over 30 countries PSI socially markets short-term contraceptives including oral contraceptives, injectables, emergency contraceptive (EC), fertility awareness methods such as Cyclebeads®, and male and female condoms. ® In addition, PSI offers long acting and permanent methods (LAPMs) including the Intrauterine Device (IUD), contraceptive implants and voluntary surgical contraception (VSC).

Short-term Contraceptives

• Oral contraception

The key to a successful family planning program lies in the wide range of contraceptive choices available to women and couples. Oral contraceptives (OCs) are a highly effective and safe method of contraception that should be made available as a choice to women and couples in need of family planning.

PSI began socially marketing OCs in Bangladesh in 1976. Since then, PSI has introduced combined oral contraceptives in over 30 additional countries. PSI currently socially markets OCs in Benin, Cameroon, DRC, Guinea, Mali, Togo, Nigeria, Rwanda, Kenya, Uganda, Tanzania, Mozambique, Malawi, Madagascar, Zambia, Zimbabwe, Paraguay, Nicaragua, Haiti, India, Pakistisan, Cambodia, Myanmar, Kazakhstan, Kyrgyzstan, and Tajikistan.

In 2008 alone, PSI sales of OCs surpassed 28 million cycles, which translates into nearly than 2 million Couple Years of Protection* (CYPs) against unintended pregnancy.

PSI's marketing strategies for OCs are aimed at creating consumer demand by addressing the key barriers to use. PSI meets demand by ensuring that health service providers (where clients usually go for advice on hormonal methods) are knowledgeable about the method. These goals are achieved through educational and communication activities such as direct marketing, advertising, interpersonal communication with community health workers, and mass media campaigns targeting both consumers and service providers. Service provider campaigns are often executed through the use of a PSI detailing force.

To supplement marketing activities, PSI trains service providers in family planning counseling and method administration. Service providers include doctors, paramedics, and pharmacists, as they are often the first points of contact for clients interested in learning about these methods. Notable examples of PSI's work in training service providers include the Green Star project in Pakistan and the ProFam project in Zimbabwe.

* CYP is the estimated protection provided by contraceptive methods during a one-year period, based upon the volume of all contraceptives sold or distributed to clients during that period.

Emergency contraception

Emergency contraception pills (ECPs) are a way of reducing the risk of pregnancy after unprotected intercourse. Often referred to in the U.S. as “the morning after pill,” EC is post-coital hormonal contraception for use when another contraceptive method fails or no contraception was used. EC involves taking a certain dosage of regular birth control pills within 120 hours of unprotected intercourse. ECPs work by preventing pregnancy. If a woman is already pregnant when she takes EC, the pregnancy will not be disrupted.

ECPs socially marketed by PSI are Progestin-only pills containing levonorgestrel, which have been shown to be more effective and have fewer side effects than combined pills, which contain both progestin and an estrogen. Like other contraceptives, EC offers another way to prevent unwanted pregnancies. However, because it is not as reliable as other contraceptive methods (efficacy rates of only 75% compared with 99% for OCs), it is not recommended for use as a regular method.

Worldwide there is a lack of awareness among both service providers and consumers of pregnancy prevention options available to women once unprotected intercourse has occurred. PSI’s objective in social marketing EC is to decrease the incidence of unintended pregnancies by making EC an option available to women who have had unprotected intercourse. Another objective is to train providers to counsel women who receive EC on the use of a regular, more reliable family planning method and to provide them with the family planning method of their choice.

PSI meets its objective by designing EC social marketing programs that:

• Create awareness of EC through advertising and educational efforts.
• Build service provider knowledge of EC and how to appropriately administer it to their clients through training.
• Make the product readily available through sales and distribution efforts.
• Make the product affordable.
• Make the product acceptable through public education and advocacy.

PSI is currently implementing EC programs in India, Kenya, Nigeria, Paraguay, Myanmar, Zimbabwe, and Pakistan.
For more information on ECPs and other emergency contraceptive options, visit http://www.cecinfo.org/index.php

Injectable contraception

Progestin-only injectable contraceptives (PICs) are a highly effective, safe, and convenient method of contraception that should be made available as a choice to couples in need of family planning.

Injectables are the fifth most popular method worldwide, after female sterilization, the intrauterine device (IUD), oral contraceptives and condoms. In sub-Saharan Africa, injectables are the most popular method, chosen by 38% of women using modern methods. By 2015 worldwide use is projected to reach nearly 40 million—more than triple the 1995 level. In 2008 alone, PSI's social marketing programs worldwide generated nearly 1.4 million couple years of protection (CYPs) from PICs.

In December 1995, PSI launched its first progesterone-only injectable contraceptive social marketing programs in Guinea and Nigeria. PSI now markets PICs in Benin, Cambodia, Cameroon, DRC Congo, Haiti, India, Kenya, Madagascar, Malawi, Mali, Myanmar, Nicaragua, Nigeria, Pakistan, Rwanda, Togo, Zambia and Zimbabwe, having provided over 1.7 million CYPs since 1995.

Standard Days Method, Cyclebeads

The Standard Days Method (SDM) is a fertility awareness-based method that relies on a fixed "window" of fertility that makes it easy for women to know when they are likely to become pregnant. To avoid pregnancy, a woman with a menstrual cycle between 26 and 32 days long should not have unprotected intercourse on days 8 through 19 of her cycle. A color-coded string of beads, called Cycle Beads™, are used to help women keep track of the days of their menstrual cycle and see which days they are likely to get pregnant.

An efficacy trial found that the SDM was more than 95% effective with correct use and more than 88% with typical use among women who reported regular cycles of 26-32 days.

PSI launched SDM in 2004 in the Democratic Republic of the Congo, and now distributes the product in Benin, Madagascar, Mali, Nigeria and Rwanda. Since the inception of the program, nearly 100,000 units have been sold, generating about 200,000 couple years of protection. When possible, SDM is integrated into the mix of other hormonal and non-hormonal contraceptive methods available for woman.

SDM offers women a variety of benefits. It is a natural family planning method that does not contain hormones nor require a medical procedure; therefore, the method has no side-effects. Additionally, because one package will last for years, and does not need to be refilled,, it is inexpensive in the long-term. A client also does not have to be a medical provider or pharmacists to receive the method, but can find it in non-specialized shops.

Male Condom

The latex male condom is a barrier method which, when used correctly and consistently during sexual intercourse, helps reduce the risk of sexually transmitted infections, including HIV, and unintended pregnancy. PSI uses private-sector marketing strategies to increase demand for and access to attractively packaged and affordable high-quality male condoms.

Using traditional (pharmacies, health clinics) and non-traditional (bars, hotels, brothels, kiosks, and salons) sales outlets, PSI reaches populations that may not otherwise have access to commercial condom brands. PSI generates demand by fostering behavior change through culturally appropriate mass media and interpersonal communication campaigns.

Since 1970, PSI has distributed over 7.8 billion male condoms in over 60 countries.

Female Condom

The female condom is a barrier method which, when used correctly and consistently, provides protection against HIV, sexually transmitted infections and unintended pregnancy. The female condom can be inserted up to eight hours prior to sexual intercourse and is currently the only female-initiated HIV prevention method.

The Female Health Company recently released a second generation of the female condom known as female condom 2 (FC2). FC2 has the same design and instructions for use as the original female condom. However, the sheath with its outer ring is now made from synthetic nitrile, as opposed to polyurethane, to improve affordability—particularly when manufactured in large volumes—while maintaining the high quality and reliability of the original female condom. Gradually, all PSI FC interventions will transition to offer FC2.

PSI first began marketing female condoms in 1995 in Zambia and, as of 2006, PSI and its affiliates have sold more than 15 million female condoms for prevention of HIV/AIDS and unwanted unintended pregnancy to low-income populations in 30 countries. PSI collaborates with the Female Health Company, which produces the female condom, as well as groups such as UNFPA, to open markets for and to increase access to the female condom in developing countries. PSI has also used innovative strategies to market female condoms to men who have sex with men in Myanmar and Thailand.

Long-Acting and Permanent Methods

Every year, there are 66 million unintended pregnancies, and more than 500,000 women die from pregnancy-related causes. Almost all of these deaths take place in developing countries. Increasing access to and use of highly effective long acting and permanent Methods (LAPM), such as the intrauterine de¬vice (IUD), contraceptive implant, and voluntary surgical contraception (VSC) can significantly reduce both maternal and child mortality and morbidity by enabling women to plan and space their pregnancies.

• IUDs

The IUD is an inexpensive long-term, highly effective, and completely reversible contraceptive method. While IUD users tend to be highly satisfied with the method, the number of users remains low largely due to provider- and consumer- barriers, such as, lack of trained and experienced providers; labor and time required for insertion compared to other contraceptive methods; poor product reputation stemming from negative experiences with older models; myths and misconceptions; and price of insertion services.

Between July 2008 and September 2009, PSI provided more than 210,000 IUDs to women around the world. PSI’s success demonstrates that despite long-standing barriers, many women, when properly counseled, do want IUDs.

• Contraceptive Implants

Like IUDs, contraceptive implants are a highly effective, reversible long-term method. New product technological improvements (resulting in 1 and 2 rod implants) have simplified insertion and removal making this an attractive product offering for providers. Additionally, because pelvic exams and vaginal contact are not required, some consumer and provider barriers are reduced.

Between July 2008 and September 2009, PSI provided approximately 56,000 women with contraceptive implants.

• Voluntary Sterilization

For both men and women, voluntary surgical sterilization (VSC) is a popular and well-established method of contraception. It offers highly effective protection against pregnancy, it carries a very low risk of complications when performed according to accepted medical standards, and, as a once-only procedure, it eliminates the need for long-term contraception. Unmet need for VSC persists due to the inaccessibility and variable quality of VSC services in many developing countries.

In Pakistan, the PSI's Green Star clinic network launched Voluntary Surgical Contraception (VSC) services for women in August 2001. The purpose of this pilot project was to integrate VSC services into the already existing Green Star clinic network as an additional reproductive health service. The VSC service provides yet another family planning option by offering tubal ligation services to women who have completed their families.

Key to Success: Linking Supply and Demand

PSI has learned that the key to increasing use of LAPMs is matching skilled, reliable and affordable supply with informed demand. PSI clinic support teams offer training, equipment, and logistical support as well as supervised coaching to providers. PSI actively reaches out to potential clients educating them on the benefits of the methods, addressing any myths or misconceptions and linking them to skilled providers where they can access subsidized LAPM products and services. The result is increased client flow to providers who are skilled, confident and motivated to offer LAPM services.

PSI’s evidenced-based, targeted communication activities generate demand using community mobilizers who conduct outreach among women and couples using interpersonal communication (IPC) techniques (often incorporating testimonials from satisfied LAPM users) and print materials.. PSI also targets providers with messages designed to overcome commonly held misconceptions about LAPMs and provides them with training, on-going supervision and support as well as the opportunity to practice their skills on an on-going basis. PSI also conducts advocacy with professional groups of providers at the country-level.

On the supply side, PSI’s franchised networks of private sector providers offer LAPM services that are marketed under a common brand, designed to symbolize high-quality services. Qualified providers from the public, private and NGO sector comprise PSI’s accredited networks. Both franchise and accredited networks demonstrate to providers that adding LAPMs to their clinical offerings is a value added for their medical practice as it can increase their client volume. PSI also partners with Ministries of Health to have dedicated LAPM providers in high volume public sector facilities.

Improving Maternal and Child Health

Preventing Iron Deficiency Anemia

The World Health Organization estimates that 2 billion people in the world suffer from anemia. Approximately half of all cases of anemia are due to iron deficiency, the inadequate intake and poor absorption of iron, although parasites and diseases such as malaria can also lead to reduced iron absorption. Most at risk for iron deficiency anemia (IDA) are women, infants and children due to increased demand for iron during growth and pregnancy.
Anemia is an important maternal health area to address since it is estimated to be associated with 20 percent of worldwide annual maternal deaths as a result of women’s reduced ability to survive postpartum hemorrhage – bleeding during and after childbirth. Anemia also negatively impacts child health: in infants and children it is associated with pre-term births, retardation of physical growth and impairment of cognitive development, as well as reduced resistance to infections and disease. Children from anemic mothers alsotend to have low birth weight and reduced iron stores.

Since 1999, PSI has socially marketed nutrition products targeted to pregnant and lactating women with the goal of improving maternal and child health outcomes. PSI also provides increased access to family planning which reduces the impact of IDA by allowing women to optimally space their pregnancies.

Iron Folic Acid (IFA)

To help prevent iron deficiency anemia among pregnant and lactating women, PSI/India developed Vitalet-Preg, an iron-folic acid supplement designed specifically to meet the increased need for iron during pregnancy. This is a particularly important intervention to implement in India where it is estimated that close to 70% of all pregnant women suffer from anemia. Prevalence of anemia in India is high due to low dietary intake, poor availability of iron and chronic blood loss due to hook worm infestation and malaria.

Regular use of Iron-Folic Acid (IFA) supplements protects a woman's health by helping her body store iron, and preventing a plunge into iron deficiency anemia during pregnancy and delivery. In addition, IFA provides a woman with sufficient folic acid before pregnancy, preventing neural tube defects that can occur during the first few weeks of fetal gestation.

Multivitamins

PSI’s assessments of vitamin markets in all regions of the world provide consistent findings: although shelves are crowded with vitamin products, closer inspection reveals them to be high-priced, exclusively high-end, with formulations typically containing so little iron and other vitamins that they are useless in addressing micronutrient deficiencies. Most are not packaged attractively nor promoted actively, nor is any effort made to educate low-income groups about their benefits.

PSI programs in India, Togo, Dominican Republic, and Paraguay market a "one-a-day" multivitamin containing iron, folic and other essential vitamins needed by women of reproductive age. These supplements, together with targeted communication and educational programs, improve the nutritional status of low income women before, during and after pregnancy. Vitamin supplements are a sustainable health intervention as they can create large scale health impact at a cost of less than 1 cent per day per beneficiary.

PSI programs in India, Togo, Dominican Republic, and Paraguay market a "one-a-day" multivitamin containing iron, folic and other essential vitamins needed by women of reproductive age. These supplements, together with targeted communication and educational programs, improve the nutritional status of low income women before, during and after pregnancy. Vitamin supplements are a sustainable health intervention as they can create large scale health impact at a cost of less then 1 cent per day per beneficiary.

Preventing Maternal Injury and Death

Women worldwide continue to die from pregnancy-related causes at a rate of one woman per minute. These preventable deaths overwhelming occur in developing countries where the lifetime risk of dying during pregnancy or childbirth is 1 in 75 compared to 1 in 7,300 in industrialized countries. An estimated 536,000 worldwide maternal deaths occur annually, and an additional 10 million women suffer lifelong disabilities due to pregnancy-related causes.

PSI works to prevent maternal injury and death by ensuring that women and birth attendants have access to low-cost, low-tech interventions, such as Clean-Delivery Kits, and where permitted according to national law, misoprostol to reduce Post-Partum Hemorrhage (PPH) and approved medical abortion drugs to prevent unsafe abortion. PSI programs also work to reduce injury during childbirth by encouraging the abandonment of female genital cutting (FGC).

Clean Delivery Kits

In countries with a high proportion of home births, delivery can be made safer by preventing infection through the use of a clean delivery kit (CDK). A CDK provides the necessary tools and instructions to achieve the World Health Organization's "Five Cleans" throughout the birthing process:

1. Clean hands. Wash hands with clean water and soap, once before delivery, and once before cord cutting.
2. Clean delivery surface. A plastic sheet for mothers to lie on during delivery maintains a clean birth canal and perineum, and protects the newborn from potential sources of infection.
3. Clean cord cut. A new razor blade in its original packing is sterile, and can prevent the transmission of tetanus-causing spores and other pathogenic organisms via the umbilicus to the infant.
4. Clean cord ties. Additionally, the use of clean thread or narrow tape to tightly tie the umbilicus helps keep the stump healthy.
5. Clean cord stump care. Keeping the umbilical stump dry and clean is the best care. If soiled, the umbilical stump may be washed with soap and clean water.

Most births in rural areas of developing countries take place at home, often without medical assistance. The CDK can reduce maternal and child mortality. PSI offers clean delivery kits in Democratic Republic of Congo, India, Nepal, Pakistan and Uganda.

Misoprostol to Reduce Postpartum Hemorrhage

The largest single cause of maternal death is postpartum hemorrhage (PPH). A woman who suffers from excessive bleeding after childbirth can die in as little as two hours unless she receives immediate and appropriate care. In Africa and Asia, where many women continue to give birth at home or in under-equipped and over-burdened facilities, PPH is estimated to be responsible for over 30% of maternal deaths.

To help prevent and treat PPH in low-resource settings, PSI promotes, distributes and trains providers in the safe use of misoprostol, a drug effective in reducing postpartum bleeding. Misoprostol is a generically available prostaglandin that reduces the risk of PPH when administered orally, immediately after birth.

Misoprostol is safe and effective, relatively inexpensive and causes few side effects. Unlike other drugs used to prevent or treat PPH, misoprostol is heat-stable and comes in tablet form, meaning it does not require refrigeration, nor must it be administered via injection or IV. As a result of these qualities, misoprostol has incredible potential to reach women in resource-limited settings. In many developing countries, medical facilities, particularly at the secondary and tertiary levels, are not always equipped with cold chain storage nor do they always have skilled providers on-site. Additionally, large numbers of women in the developing world continue to give birth outside of a facility and/or without the attendance of a skilled provider. Providing a drug that can reduce the risk of PPH for women in these settings is an important step to reducing maternal mortality globally.

Use of misoprostol for prevention of PPH in resource-limited settings is supported by the International Federation of Gynecology and Obstetrics (FIGO), the Prevention of Postpartum Hemorrhage Initiative (POPPHI), the United States Pharmacopeia, and the World Health Organization.

PSI operates misoprostol for PPH programs in Nigeria, Somaliland, Tanzania, Uganda and Zambia. Additionally, PSI contributes to partner programs for misoprostol for PPH in Mozambique.

Reducing Unsafe Abortion

Worldwide, at least 13% of maternal mortality is attributed to unsafe abortion. Every year, 70,000- 100,000 women die from unsafe abortion and an additional 5 million are hospitalized for related complications, which often result in permanent disabilities. The majority of these women are from the poorest areas of developing countries, and their deaths have far reaching consequences for their children, families and communities.

PSI seeks to save women’s lives and reduce the morbidity caused by unsafe abortion. PSI makes quality contraceptives available in order to enable women to avoid unintended pregnancies, estimated to be approximately 76 million in the developing world, annually. In four countries: India, Cambodia, Nepal and South Africa, where abortion is legal yet unsafe abortion practices continue, PSI also works to increase access to WHO-approved medical abortion drugs. These drugs are a safe alternative to the dangerous abortion methods and products that lead to increased maternal morbidity and mortality in these countries.

Abandoning Female Genital Cutting

Female Genital Cutting (FGC) is a major public health challenge, facing an estimated 100 to 140 million girls and women in 28 countries in Africa, certain countries in the Middle East and South Asia, and in Diaspora communities worldwide. There are no known medical benefits to FGC. Short term effects include severe pain, psychological injury, and even death. Some of the more long term consequences include fistula, vaginal tearing during intercourse or childbirth, internal haemorrhage, bladder and urinary tract infections and infertility. According to the WHO complications during childbirth are also significantly more likely to occur and can lead to an additional 1 to 2 perinatal deaths per 100 babies. As a leader in Behavior Change Communication, PSI programs in Mali and Guinea work through local staff to improve the health and well-being of women and girls by encouraging the abandonment of FGC with support from KfW and USAID.