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This paper explores sexual and reproductive health and rights (SRHR) among young people, identifying intersecting factors that create inequities in access to services, health-seeking behaviour, and ultimately health outcomes. Based on qualitative interviews with young people in the Maldives, it demonstrates how these intersectional experiences are contrary to what is often assumed in official data, policies, and services. Three factors were found to shape young people's experiences: marital status, gender, and urban/rural differences. Non-marital sexual activity is illegal in the Maldives, but it is somewhat expected of unmarried men, while unmarried women are stigmatised for being sexually active. Although access to SRH services is restricted for all unmarried people, young women face additional difficulties, as the risk of being exposed is much greater in small island communities. Maldivian island communities are extremely small and characterised by an inward-looking culture that exerts considerable social pressure, particularly on unmarried women. For an unmarried woman, being known to be sexually active, or worse, pregnant outside of marriage, has severe social consequences including stigma and isolation from the community, and their own family. This concern is more prevalent among rural young women, as they live in smaller communities where stigma is inescapable. The need to avoid public scrutiny and humiliation contributes to making unsafe abortion a common solution for many unintended pregnancies. Failure to acknowledge these intersecting factors in SRHR experience and access has led to inequities among an already overlooked population, shaping their experiences, knowledge, health-seeking behaviour, and health outcomes. [ABSTRACT FROM AUTHOR]

Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement. [ABSTRACT FROM PUBLISHER]

This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use. [ABSTRACT FROM AUTHOR]

Context: The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken.Objective: To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs.Methods: We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations.Results: We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered.Conclusion: The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies. [ABSTRACT FROM AUTHOR]

A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming. Dans la santé, une franchise sociale est un réseau de praticiens privés à but lucratif tenus par contrat d'assurer des services socialement bénéfiques sous une même marque. Au début du XXIe siècle, les donateurs ont encouragé avec beaucoup d'enthousiasme les franchises sociales pour les services de santé génésique. Se fondant sur un recueil d'informations descriptives relatives à 45 franchises sociales cliniques, situées dans 27 pays d'Afrique, d'Asie et d'Amérique latine, cet article examine leur contribution à l'accès universel à des services globaux de santé génésique. Il révèle que ces franchises n'ont pas élargi l'éventail de services de santé génésique, mais se sont principalement centrées sur la contraception et, dans une moindre mesure, les soins maternels et l'avortement. Dans de nombreux cas, la couverture n'avait pas été étendue à de nouvelles zones. Les mesures prises pour garantir la viabilité vont à l'encontre de l'objectif d'accès des groupes à faible revenu. Dans près des deux tiers des franchises, le coût total de l'ensemble des services devait être payé par les patients et était inabordable pour les femmes à faible revenu. Les normes et les protocoles d'assurance qualité étaient en place dans toutes les franchises, mais on dispose de données limitées sur leur observance. Des entretiens informels avec des patients ont indiqué qu'ils étaient satisfaits des services. Néanmoins, les difficultés pour recruter des franchisés et une certaine usure, l'incapacité des franchisés de suivre des programmes de formation, l'utilisation d'agents de santé profanes pour assurer des services sans soutien ni supervision et des problèmes logistiques pour appliquer les outils d'assurance qualité sont autant de facteurs préoccupants. La contribution des franchises sociales à l'accès universel aux services de santé génésique paraît incertaine. Il ne semble pas justifié de continuer d'investir en leur faveur pour la prestation de services de santé génésique, à moins que de nouvelles données ne prouvent leur utilité. Una franquicia social en salud es una red de profesionales de la salud particulares con fines de lucro, vinculados mediante contratos para ofrecer servicios de beneficio social bajo una marca en común. A principios del siglo XXI se ha visto un considerable entusiasmo por parte de donantes para promover las franquicias sociales para la prestación de servicios de salud reproductiva. Basado en un compendio de información descriptiva sobre 45 franquicias sociales clínicas, situadas en 27 países de Ãfrica, Asia y Latinoamérica, este artículo examina su contribución al acceso universal a los servicios integrales de salud reproductiva. Se encontró que estas franquicias no han ampliado la gama de servicios de salud reproductiva, sino que se han centrado principalmente en servicios de anticoncepción y, a menor grado, en servicios de salud materna y de aborto. En muchos casos, no se había extendido la cobertura a nuevas áreas. Las medidas tomadas para garantizar sostenibilidad eran contrarias al objetivo de acceso para grupos de bajos ingresos. En casi dos terceras partes de las franquicias, las pacientes tuvieron que pagar el costo total de todos los servicios, inasequible para mujeres de bajos ingresos. Aunque todas las franquicias habían establecido normas y protocolos para garantizar la calidad, había limitada evidencia de su cumplimiento. Las entrevistas informales con pacientes indicaron satisfacción con los servicios. No obstante, preocupan factores como las dificultades en reclutar franquiciados y una considerable amortización de puestos de trabajo, la imposibilidad de los franquiciados de asistir a programas de capacitación, el uso de trabajadores de la salud laicos para proporcionar servicios sin apoyo o supervisión, y los problemas logísticos aplicando las herramientas de garantía de la calidad. La contribución de franquicias sociales al acceso universal a los servicios de salud reproductiva parece ser incierta. A menos que surja más evidencia de su valor, no se justifica continuar invirtiendo en ellas para la prestación de servicios de salud reproductiva. [ABSTRACT FROM AUTHOR]