Reproductive health service providers face more challenges than ever: the HIV/AIDS pandemic, increasing rates of other sexually transmitted infections, persistently high rates of maternal mortality in resource-poor settings, and a large population of new clients, including adolescents and men. Since 1998, the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS), funded by the United States Agency for International Development (USAID), has employed “operations research” to identify the most effective and affordable ways to address critical reproductive health issues. 
Both men's and women's family planning knowledge and behaviors changed markedly after participating
in the "Men in Maternity" program in New Delhi. A similar FRONTIERS study is under way in KwaZulu-Natal, South Africa.Photo credit: Population Council/India; |
Findings from this practical research methodology are enabling governments and program managers around the world to advance and support voluntary programs to reduce unintended pregnancy and promote healthy behaviors. Strong working relationships with health agencies, community- and faith-based groups, and policymakers in 30 countries are increasing understanding of how to improve coverage, quality, and sustainability of services, and of the areas in service delivery over which program managers can actually have influence. FRONTIERS works in the following areas: Intervention and evaluation studies to demonstrate the feasibility and acceptability of new service-delivery approaches or to test the impact and cost-effectiveness of different policy options Technical assistance in the scaling-up or adaptation of successful interventions to different locales Building local operations research capacity in collaboration with donor agencies and developing-country service providers
A FRONTIERS study in Egypt found that clients welcomed discussion of sexuality during family planning counseling but preferred to have the service provider raise the subject.Photo credit: Fahmi/FRONTIERS ANE Collection |
The research cycle does not end when
data have been analyzed. FRONTIERS communicates results globally, promoting best practices and facilitating the application of results by policymakers and program managers. Findings are disseminated through FRONTIERS publications, journals, international conferences, meetings, and stakeholder workshops, and on the Internet at www.popcouncil.org/frontiers. In western Kenya, where rates of HIV/AIDS are high and rising, FRONTIERS, together with the Program for Appropriate Technology in Health (PATH), tested the effectiveness of community, school, and clinic interventions in improving young people’s knowledge of reproductive health, delaying the onset of sexual activity, and increasing access to adolescent-friendly reproductive health services. More than 100 teachers, 80 religious leaders, and 850 peer educators were trained for the intervention, which was strongly endorsed by the community. It led to greater discussion and understanding of reproductive health and encouraged safer sexual behavior among young people. FRONTIERS and PATH are providing technical assistance to the Government of Kenya to scale up activities nationally. In India, FRONTIERS and the Employees’ State Insurance Corporation (ESIC), a government-affiliated social security system for low-income workers, conducted a study in ESIC health clinics on the effect of men’s involvement in their partners’ prenatal and postpartum care. According to the study, men had great interest in participating in maternal and child health care, couples’ communication improved, and contraceptive use increased significantly. Providers and clients alike expressed satisfaction with the new services. The model was relatively inexpensive to scale up and is being adopted at additional clinics and hospitals in New Delhi. Moreover, the training and counseling model is being considered for use in other Indian states, and program materials are available for use in other countries. In Guatemala, FRONTIERS developed and is testing a new service-delivery model to expand access to the long-term contraception offered by intrauterine devices (IUDs) for women living in rural areas. The project includes training (or retraining) for nurses and nurse auxiliaries in IUD counseling, insertion, and removal, and in case management and outreach. The training emphasizes competency and requires the nurses to perform five supervised IUD insertions for clients in order to obtain certification. To date, 45 of 92 trained nurses have received certification; the training is ongoing. The certified nurses averaged seven insertions in the first three months after certification, as compared with two insertions in the previous year.  FRONTIERS is led by the Population Council in collaboration with Family Health International. More information is available at www.popcouncil.org/frontiers. |
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