For as long as there have been family planning programs, there has been family planning research. At the theoretical level, researchers examine the effect of fertility on health and socioeconomic development and study the determinants of fertility for individuals and populations. At the policy level, studies explore the role of family planning programs in modifying fertility and health. The development of new contraceptives is accompanied by clinical and pre introductory trials carried out in program settings. Surveys are conducted to measure changes in contraceptive use and fertility, and the results are used to make decisions affecting programs. Finally, programs themselves carry out operations research (OR) to improve service delivery.

The aim of this volume is to provide an overview of how operations research is used by family planning programs. The readings in this book illustrate many of the major issues and topics that have benefitted from operations research, as well as many of the research designs encountered among OR studies. The book also provides information about the problems that programs and researchers encounter in carrying out operations research and the challenges faced in translating research findings into changes in day-to-day program operations.

The first four sections in this book deal with major operations research topic areas including program impact, access, resources, and quality of care. The last section deals with issues in the conduct of OR studies and the use of OR findings. Each section begins with a brief introduction intended to provide the reader with basic information about the topic under consideration, and about the programmatic and research issues dealt with in the readings. Occasionally, section introductions also suggest areas within the section topics requiring further study. Finally, most papers are prefaced by brief remarks by the editors designed to identify the salient aspects and issues raised by each study.

This publication presents one of the data collection tools, the observation checklist, developed by the multidisciplinary team of researchers.  It was used to comprehensively document the labor and delivery experience of 176 women experiencing normal labor, at the busy obstetric teaching facility.

The Balanced Counseling Strategy Plus (BCS) job aids and guides are intended for reproductive health programs interested in both strengthening the quality of family planning counseling and responding to the needs of clients at risk for STIs, especially HIV.  The BCS User's Guide explains how to use the job aids and can be distributed during training on the BCS or used for self-teaching with the BCS job aids. The BCS is a developed and tested, practical, interactive, and client-friendly strategy for improving counseling within family planning consultations.  The BCS uses three key job aids for counseling clients about family planning; an algorithm to guide the provider through the counseling process, a set of counseling cards for contraceptive methods, and corresponding brochures for each method.  The strategy, tested and refined in several countries, compromises a series of steps to determine the contraceptive method that best suits the client according to her/his preferences and needs.  This strategy improves the quality of the provider's counseling and allows the client take ownership of the decision.  The approach is practical, low cost, and easy to adapt to local contexts.

This report describes an operations research (OR) study undertaken by the Population Council under the Demand Based Reproductive Health Commodity Project (DBRHCP) to examine the effect on utilization of maternal health care services, delivered by trained providers, through providing financial support directly to poor pregnant women through vouchers. Aiming to improve the quality of health service delivery, and particularly of reproductive health services, the National Institute of Population Research and Training (NIPORT) has implemented DBRHCP with four partners with financial assistance from the Canadian International Development Agency (CIDA) and technical assistance from United Nations Population Fund (UNFPA).

The overall objective of the study was to replicate and scale up „best practices‟ based on findings from FRONTIERS. The specific objectives of the study were: 1) To institutionalize the Systematic Screening Instrument in the entire state of Uttarakhand, India; 2) To strengthen Emergency Contraceptive Pills service provision in the entire state of Uttarakhand, India; and  3) To enhance use of the Lactational Amenorrhea Method (LAM) among Egyptian women. The present report has been divided into two parts. In the first part, implementation of the SSI and ECP activities has been presented jointly, as these activities were implemented together in Uttarakhand. The second part of the report describes activities implemented in Egypt to build national capacity regarding correct use of LAM and for providing postpartum and postabortion family planning.

This report presents findings from an exploratory study of the pregnancy-related morbidity and mortality experiences of women who delivered in adolescence and adulthood, and the constraints they faced in seeking appropriate and timely care, in the state of Rajasthan.

The broad objective of the study is to assess the need for and acceptability of ECP by women in Bangladesh. Besides, special attention was paid to develop, test and document the operational plans for introducing emergency contraception pills as backup support to existing family planning methods. More specifically, the study intended to determine the acceptability and appropriate use of ECP among married women, identify the most appropriate and cost-effective service delivery model to make ECP accessible and test and document how best ECP could be introduced without adversely affecting the use of other family planning methods.

In the 1990s, the government of Senegal implemented a series of policy changes for the provision of family planning services through the public sector. A strategy to provide high quality services through reference centers was adopted. This paper presents findings from a longitudinal survey of 1.320 Senegalese women who had sought family planning services at ten public sector facilities - five reference centers and five health centers. Information was collected on the quality of care they received at the time they adopted family planning. One thousand one hundred and ten of the respondents were followed up sixteen months later to ascertain their contraceptive status. The first principal finding was that attendees at reference centers reported receiving relative better care than those who attended health centers. On average, clients at reference centers received 4,3 out of five units of care, compared to 3,8 units as reported by health centre clients. Second, multivariate analyses indicated that quality of care received at the time of adopting a contraceptive has a significant influence on subsequent contraceptive use. Those who received good care were 1,3 times more likely to be using a method than others.

This study is meant to explore sexual and reproductive health (SRH) experiences and needs of women living with HIV/AIDs in Mexico.  It was also meant to give recommendations to improve SRH and HIV services for women.

This policy brief documents the magnitude of self-reported pregnancy-related morbidity among low-parity adolescent and adult women, and the constraints that they faced in seeking appropriate and timely care in Rajasthan. It also sheds light on the extent to which morbidity and the constraints experienced in seeking care differ across social classes.

This article was meant to cover a workshop whose objectives were: To increase understanding of the importance of integrating postpartum/postabortion care with family planning services, in efforts to improve the health of mothers and children in the Arab region; To share best and promising practices in providing family planning services, especially those within postpartum and postabortion care;  To orient participants in adapting best and promising practices in their own programs through practical sessions and working groups;  To recognize the role of operations research in enhancing the integration of family planning services with postpartum/postabortion care.

This report is the result of a project entitled “Safe Motherhood through Community Mobilisation,” undertaken as part of the Health and Population Innovation Fellowship (HPIF) awarded to the author in 2004.

This report describes a south-to-south collaboration to assist the Ministry of Health of Pakistan to introduce emergency contraception (EC) into its family planning program, supported by the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program. The collaboration consisted of a three-day visit by senior managers from the Pakistani health authorities to Bangladesh to familiarize them with the EC program in that country, followed by a two-day consultative meeting in Islamabad, Pakistan to draw up concrete plans for introduction of the method into the Pakistan system.

This handbook presents a methodology that seeks to address a knowledge gap. Termed the Assessing Integration Methodology, or AIM, it has been developed from experience gained by the Population Council in undertaking assessments of various combinations of integrated services in many developing countries, most of which was undertaken through the USAID-funded Frontiers in integrated services. The handbook (a) explains the basic principles of conducting studies using AIM, (b) provides tips for the data collection, and (c) makes available data collection instruments that have been validated in projects throughout the developing world. The map on the previous page highlights those countries in which FRONTIERS carried out projects utilizing the AIM strategy.

This BCS+ User’s Guide on how to implement the BCS+. It explains how to use the job aids and can be distributed during training on BCS+ or used for self-teaching with the BCS+ job aids.

The Regional Centre for Quality of Health Care at Makerere University, in collaboration with the Delivery of Improved Services for Health II (DISH II) Project, the Ministry of Health of Uganda, and the Population Council’s FRONTIERS Program, conducted an Operations Research project to help the Ministry of Health improve the quality of family planning services with the aim of helping couples better attain their reproductive goals. The study developed a package of interventions that sought to increase the readiness of clinics to offer basic family planning services, to improve provider motivation, and to empower clients to request quality services. The project then tested the feasibility of implementing these interventions, and evaluated their effect on the quality of client-provider interactions.

Despite the tremendous resources invested in training Traditional Birth Attendants (TBA) over the past two decades, scientific evidence from around the world has shown that training TBAs has not reduced maternal mortality. Any improvement observed when TBA training programmes have been introduced was because of the associated supervision and referral systems, and because of the quality of essential obstetric services available at first referral level.  Since TBAs are highly regarded by their communities, it is critical that they still be encouraged and enabled to play a role in improving maternal health. The Kenya Safe Motherhood Demonstration Project (SMDP) has identified the contributions that TBAs can make, so that they are incorporated into a national plan for maternal and neonatal health during the transition to Skilled Attendance at birth.

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral or PROCOSI) is a network of 24 Bolivian NGOs that coordinates and implements programs to improve the health of the population in need. In 2000, PROCOSI received funding from the USAID Mission in Bolivia to institutionalize a gender perspective in the reproductive and sexual health services offered by the PROCOSI network.  PROCOSI and the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS) took advantage of this opportunity to evaluate the effects that interventions had on clinic clients and their partners, and to estimate the costs of incorporating a gender perspective into service delivery.  The project aimed to answer four questions: 1) Can health organizations operationalize a gender perspective? 2) Does the incorporation of a gender perspective have a positive effect on the health and well being of the users and on their relationships with their partners? 3) Does this have an effect on the demand for sexual and reproductive health services? 4) Which would be the cost of incorporating a gender perspective into the delivery of reproductive health services?

This report presents the results of an operations research project to increase male involvement in family planning in Peru.  The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

Evidence from a number of studies globally has shown a reduction in maternal and perinatal mortality when women have a skilled attendant present at every birth. In Kenya, although over 88% of women attend an antenatal clinic at least once during pregnancy a skilled attendant assists only 42% at birth. There are regional disparities within Kenya on who provides support during childbirth. In Central Province, over 70% deliver with a skilled attendant compared to 28% in Western Province.  Building on these results, a Community Midwifery Model was developed by a collaborative group of professionals.  This report discusses the Community Midwifery Model in detail.