These populations are often marginalized and disproportionately affected by adverse health events. We create targeted interventions to ensure accessible and affordable products and services reach them.
Today, there are over 1.8 billion young people between the ages of 10 and 24 globally; 90 percent of them living in developing countries (USAID, 2012). Despite technological progress that has led to unprecedented opportunities for young people, significant barriers limit young people’s access to crucial sexual and reproductive health information and services, including lack of knowledge and skills to access health services, unwelcoming and judgmental healthcare providers, restrictive policies that limit young people’s contraceptive choices and deep-rooted cultural and gender norms.
We are addressing these challenges through innovations in health service delivery, behavior change communication (BCC), and addressing the social, economic, legal, and cultural factors that make youth vulnerable.
Male Partners and Couples
Many women wish to use contraception but do not do so because they think their partner would object. When couples talk about contraception, they are more likely to use it. Moreover, communication campaigns can increase couple communication about family planning and adoption of a contraceptive method (Sharan & Valente. International Family Planning Perspectives 2002; 28).
We aim to engage men and women alike in joint decision-making about their reproductive health and childbearing. Our social marketing of family planning often includes messages and communication channels designed to reach men and couples. In the Democratic Republic of the Congo, for example, male community health workers seek out men where they work and gather to discuss family planning options and dispel myths and misconceptions.
Most health problems disproportionately affect the poor, and we design strategies to ensure that products and services are available to them by providing subsidies, generating demand and improving availability.
Maternal mortality, or death during and immediately after childbirth, occurs much more often in low-income countries than in wealthy ones. Globally, over 12 percent of women want to prevent or delay pregnancy, but are not using any method of contraception. In low-income countries, this increases to an average of 22 percent of women (WHO Global Health Observatory Data Repository, Unmet need for family planning 2011).
Within countries, the difference is even starker. Ranking women by wealth within countries, studies have shown that for the poorest 20 percent of women in Sub-Saharan Africa, only 31 percent of their need for contraception is met, while for the richest 20 percent of women in those same countries, 62 percent of their need is met (Studies in Family Planning 2010; 41: 101–108).
Even within a country, poor women have more trouble accessing family planning than their wealthier neighbors. Less access leads to early pregnancy, more frequent pregnancy and unwanted pregnancy – all of which are related to increased risk of maternal death.
There is a global consensus that improving access to family planning is imperative. We contribute to this important priority by socially marketing a range of high-quality family planning products in 51 low and middle-income countries. We use approaches such as vouchers, mobile services, subsidies and information, education and communication tools to ensure that family planning is accessible and affordable for low-income women.
Reaching postpartum women with reproductive health services is a critical component to decreasing maternal mortality and unmet need among women who want to limit or space their births.
In developing countries, the large majority of women do not want to have another child within their first year postpartum, yet less than 37 percent are using a family planning method. Waiting at least 3 years following a delivery to get pregnant again can significantly decrease the risk of adverse maternal and child health outcomes.
We strive to make it as easy as possible for women to receive health services at every stage in their life to ensure their own health and that of their children. Our programs integrate contraceptive services tailored to women’s needs into prenatal care visits, delivery, postnatal visits and immunization services, as well as post-abortion care visits whenever possible.
We also have programs in postpartum hemorrhage, the largest single cause of maternal death. Our network also promotes, distributes and trains providers in the safe use of Misoprostol, a drug effective in reducing postpartum bleeding.
Additionally, we train providers in postpartum IUD (PPIUD) insertion and removal for women seeking non-hormonal protection from pregnancy immediately following delivery.
Female sex workers
Female sex workers are vulnerable to HIV infection and unintended pregnancies because of the frequency of sexual contacts, high numbers of sexual partners, and their limited power to negotiate condom use and resist violent or coercive sex.
Given the context for female sex workers, our communication targeted to them emphasizes the importance of dual protection: encouraging them to use male or female condoms along with a modern contraceptive method in order to offer maximum protection against unintended pregnancies and STIs. Our solutions offer contraceptive and HIV services to female sex workers as part of an integrated package of sexual and reproductive healthcare in Madagascar, Cambodia, Swaziland, Zimbabwe, Zambia, Benin, Togo, Cameroon, Malawi and Mali.
Gender-based violence survivors
One in three women around the world has been beaten, coerced into sex or otherwise abused in her lifetime. (WHO 2013. Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence.)
Gender-based violence (GBV) is both a human rights issue and a major public health problem. Survivors are more likely to experience a wide range of health problems and unintended pregnancy.
While we promote couple communication about family planning, we recognize that not all women can safely raise the subject of contraception with their intimate partners. We aim to meet the diverse needs of clients, including those who do not disclose their use of contraception to their partner. Offering a wide range of methods, including private, low-cost and long-acting methods, is critical to meeting those needs.
A number of our solutions also involve training healthcare providers to respond to cases of GBV with supportive counseling, sexual and reproductive health care and referrals for other services.
Seventy percent of the world’s poor live in rural areas. We believe in equal access to care for every woman, man and child regardless of income level or location.
We expand the reach of contraception products and services to these hard-to-reach and under-served populations through mobile outreach services, special service events, task-shifting to lower level providers where possible and engaging community-based health workers .
Making a Difference
We have developed extensive training and resources designed to help providers better engage and retain young people in care.
In 2014, we published and disseminated Making Your Health Services Youth-Friendly, helps providers assess their services, identify gaps, and develop action plans that have been adapted from existing best practices. The guide provides an overview of the global need for youth-friendly service provision and offers key recommendations to develop and strengthen sexual and reproductive health services for youth.
We also conduct five-day training program for health providers that takes a participatory and applied learning approach which helps them understand the context of youth and sexual and reproductive health in their own countries, as well as basic knowledge of adolescent sexual and reproductive health development; values exploration activities, case study discussions that disentangle personal from professional values, communication and counseling skills and site visits with practice using assessment tools. So far we have trained health providers in Malawi, Liberia and Uganda, with many more trainings planned for the coming years. Our programs in the Caribbean, Haiti, Dominican Republic and Burundi are also working to establish new social franchise networks that will include youth-friendly components to increase young people’s access to sexual and reproductive health services.
PSI/Malawi began working with health providers on strengthening youth-friendly services through a training conducted in June 2013 for Tunza social franchise providers. As part of the training, providers devised group strategies as well as individual action plans to improve their skills and abilities to attract and retain young clients. One group strategy was the development of a “Youth Alert!” seal – a certificate of youth-friendly services, based on the highly popular PSI/Malawi “Youth Alert!” campaign. This seal will help young people identify service delivery sites that will provide them with comprehensive, welcoming and non-judgmental care. Read more about the nationwide “Youth Alert!” campaign.
Female sex workers:
PSI’s affiliate in El Salvador, PASMO, integrates contraceptive and HIV services to better serve female sex workers. Read about the USAID-funded Combination Prevention Program for HIV.
Other studies and programs serving female sex workers can be found in the resources below.
Studies and briefing notes can be found in the resources below.