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It's time to LEAP forward to increase access to life-saving technologies

Updated: Apr 21, 2021

©Kate Rademacher/FHI 360
©Jessica Scranton/FHI 360

Written by Kate Rademacher, FHI 360

This post originally appeared on Medium. View the original post here

Saturday is February 29 which means that 2020 is a leap year. This year also marks the thirty-year anniversary of when the hormonal intrauterine device (IUD), a long-acting, highly effective contraceptive with important non-contraceptive health benefits, was first introduced in Europe. It is also the twenty-year anniversary of when the method was first introduced into the United States. In these markets, the method has proven to be highly popular. In the United States, 12% of women using contraception use an intrauterine device and 74% of these women use a hormonal IUD.

Despite this, the method is still not widely available or accessible in low- and middle-income countries (LMICs) even though the method was added to the World Health Organization’s Essential Medicines List in 2015. For the past two years, FHI 360 has led an initiative called LEAP (Learning about Expanded Access and Potential) with funding from the Bill & Melinda Gates Foundation. The goal of the project, which is implemented in collaboration with PSI , Society for Family Health in Nigeria and Zambia, and WCG, is to help determine if and how expanded access to the hormonal IUD could increase contraceptive use and continuation rates in sub-Saharan Africa.

Earlier this month, I traveled to Nigeria and spoke to a nurse-midwife who has been providing the hormonal IUD as part of a pilot program being offered by the Society for Family Health through the PSI-SIFPO-2 project with funding from the U.S. Agency for International Development (USAID). The clinic where she works offers a full range of contraceptive options including short- and long-acting methods. This provider said, “The women like [the hormonal IUD] very much. It is still just a problem of the cost. If the cost went down, many more women would use it.”

Whenever I have spoken to women and providers in Nigeria and in other countries in the region, I have heard the same message. Women who have access to the hormonal IUD and have tried it generally like it. Providers appreciate the method’s contraceptive and non-contraceptive attributes. Globally, a key principle of client-centered family planning programs is to promote method choice by providing services that enable youth, women, men, and couples to voluntarily choose contraceptive methods that best align with their reproductive desires and lifestyle. But when it comes to this method, access and choice remain substantially constrained.

This leap year, it's time to close this thirty-year research-to-access gap.

At FHI 360, we use a research utilization framework to help accelerate the translation of evidence into practice and to help facilitate new product introduction. Through this work, I’ve seen firsthand how intentional, coordinated efforts that engage multiple stakeholders — including governments, donors, suppliers, service delivery groups, and communities — can help break down barriers that have historically reduced affordability and access to health commodities including contraceptives. For example, a multi-year initiative that FHI 360 led helped dramatically increase access to contraceptive implants worldwide.

© ??In February 2020, stakeholders met in Abuja to identify steps to increase access to the hormonal IUS
In February 2020, stakeholders met in Abuja to identify steps to increase access to the hormonal IUS

With the hormonal IUD, we are also starting to see progress. For example, earlier this month stakeholders gathered for a two-day meeting in Abuja that was sponsored by the Federal Ministry of Health. Over forty partners met to identify concrete steps that can be taken at the national and state levels to support phased introduction of the method on a broader scale in Nigeria. At the international level, a global working group which is convened by USAID has facilitated collaboration among donors, suppliers, procurement agencies, researchers, and service delivery groups to identify supply- and demand-side solutions to increase access.

This leap day, it is time to leap forward. As a global health community we must recommit ourselves to finding new and innovative ways to reduce the amount of time it takes to ensure that life-saving health technologies reach populations in LMICs including the hormonal IUD.

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