E2A Newsletter, May 2014

Conference co-hosted by E2A joins domestic, international reproductive health experts to share best practices, evidence gaps

Maureen Norton (R) and Katie Taylor (L) of USAID's Bureau for Global Health open the meeting Throughout the Reproductive Life Course: Opportunities and Challenges for Empowering Girls and Women

Two US agencies with common goals—the US Agency for International Development (USAID) and the US Health Resources and Services Administration (HRSA)—converged to kick off a collaborative conference, Throughout the Reproductive Life Course: Opportunities and Challenges for Empowering Girls and Women. The two-day, invite-only conference joined sexual and reproductive health experts from the US and abroad to present practical, high-impact solutions that can be applied to improve the reproductive health of girls and women from low-income and often marginalized communities at integral points throughout their lives. The conference was supported by two of USAID’s flagship projects: the Evidence to Action for Strengthened Reproductive Health Services (E2A) Project and the Maternal and Child Health Integrated Program (MCHIP).

Speaking about the importance of the domestic-international partnership, Robert Clay, Deputy Assistant Administrator with USAID’s Bureau of Global Health opened the meeting. “We are in a global world and we can learn from each other,” said Clay. “There are lots of lessons we can learn from looking at our experience in the US as we try to achieve our goals overseas.”

Clay specifically highlighted three international health goals to which USAID is working and to which evidence presented at the conference can contribute: ending preventable child and maternal deaths, supporting the FP2020 goal of reaching 120 million more women and girls with family planning services, and achieving an AIDS-Free Generation.

Elaborating about the importance of family planning to women’s and children’s health, Katie Taylor, who works alongside Clay as a Deputy Assistant Administrator with USAID’s Bureau of Global Health, pointed out that “USAID is interested in advancing understanding among a broad range of partners about the critical impact of modern contraceptive methods and their role in child and maternal health.”

“We know about the importance of family planning in women’s lives, but we have not always been focused on the role family planning can play in ensuring women have babies at the healthiest times in their lives,” Taylor continued. “Something as simple as spacing births can be so significant in saving the lives of children under five, and lowering  maternal mortality.”

Michael Lu, as Associate Administrator of HRSA’s Maternal and Child Health Bureau and an expert on the “life course perspective,” joined Taylor to emphasize the importance of preconception and interconceptional care.

To prevent preterm birth—which Lu identified as the leading cause of racial and ethnic disparities in infant mortality in the US—“we need to start taking care of women long before they get pregnant,” said Lu. He highlighted the necessity of treating preterm birth as not just a children’s health issue, but also as a women’s health issue.

Lu spoke more broadly about how environmental factors early in one’s life can affect health across the entire life course, specifically talking about the impact of stress on maternal health, pregnancy, and, as a result, children’s health and development.

Hani Atrash, Lu’s colleague who leads HRSA’s Division of Healthy Start and Perinatal Services, presented specific ways in which the US Government is addressing reproductive health across the life course in the United States.

HRSA, for example, is in the process of developing age-specific guidelines for reproductive life planning and will work to have them adopted as standard clinical practice across states.

Those guidelines are part of a package of strategies meant to address several challenges including: the increasing rates of maternal mortality and morbidity in the US; the alarming rate of unintended pregnancies—53% of women in the US who give birth have unplanned pregnancies; and the stark racial disparities in maternal and infant health—a black baby born in the US is more than twice as likely to die as an infant than a white baby, while a black woman is three times more likely to die as a result of childbirth than a white woman.

“Although we have made significant improvements in pregnancy outcomes, we need to do more,” said Atrash.

Ten plenary and panel sessions at the conference focused on what USAID, HRSA, E2A, and MCHIP identified as the most pressing topics relevant to girls’ and women’s health:

  • Youth
  • Using Family Planning to Prevent High-Risk Pregnancies
  • Community-Based Services
  • Family Planning Integration with Health Services
  • Multisectoral Family Planning Links with Non-Health Activities
  • Integration of Empowerment or Motivational Components

Presenters identified and shared best practices related to these themes that can be applied in the US and overseas, as well as evidence gaps that need to be filled to improve the sexual and reproductive health of women and girls around the world. Participants were able to listen and contribute to both plenary and concurrent sessions, and contributed to small working group sessions on each thematic area in order to share lessons learned and draw from the diversity of field experience inherent to the audience.

To view the presentations from the two-day meeting, click here. The full program guide can be downloaded here.

Although the meeting was an invite-only event for a select group of participants, E2A will be disseminating a report from the meeting, which will compile best practices, evidence gaps, and important learning conveyed by the presenters. If you are interested in receiving the report, please contact Laurel Lundstrom at

Working within a university setting to improve sexual and reproductive health in Niger

With funding from the USAID/West Africa Mission and a close partnership with Niger’s Ministry of Public Health, E2A recently began working with students, administrators, and health providers at Abdou Moumouni University in Niamey, Niger, to both build demand for sexual and reproductive health services, and strengthen the delivery of those services to young people. E2A’s innovative approach employs a comprehensive package of behavior-change interventions, including interactive games and videos, which are designed to address both factors that encourage young people to access sexual and reproductive health services and barriers that impede them from doing so.

Niger is characterized by some of the poorest reproductive health indicators in the world. Women have an average of more than seven children in their lifetimes—many at great risk. The maternal mortality rate, according to UNICEF, is one of the highest in the world, at 650 deaths per 100,000 live births. Only 12 percent of all married women report using a modern method of contraception (2012 Niger DHS).

E2A is working with the Government of Niger to meet national goals—such as reducing the unmet need for family planning and unintended pregnancies—specifically through its partnership with Abdou Moumouni University. The choice to work with the students at Abdou Moumouni was a strategic one: these students are the vanguard of the country’s future leadership. They come from every part of Niger and are of relatively high mobility and educational attainment. The students are therefore uniquely positioned to encourage demand for youth-friendly sexual and reproductive health services both at the university itself and to the many other communities they reach.

Generating demand for sexual and reproductive health services

Nineteen student supervisors and seventy-five peer educators were identified from within the university who can lead participatory, behavior-change activities with students to transform their perceptions about sexual and reproductive health, and thereby increase their demand for sexual and reproductive health services. Students get to know more about the cultural and practical realities related to sexual and reproductive health in Niger, and learn about where they can access on- and off-campus sexual and reproductive health services. Coupled with these on-campus activities are efforts to both strengthen the delivery of and demand for off-campus sexual and reproductive health services. Given the natural reach of the student body beyond the campus to the many different regions and communities from which students come, the project touches many communities across Niger to increase knowledge about sexual and reproductive health and access to health services, particularly among young people.

Strengthening service delivery

E2A is working with university providers to ensure they provide a comprehensive package of sexual and reproductive health information and services, which includes family planning counseling, a broad range of contraceptive methods, and HIV counseling and testing. E2A is also working with the Ministry of Public Health and university health services so that students can be referred to the three local hospitals near the university when appropriate. E2A intends to collaborate with other partners in Niamey currently supporting the Ministry of Public Health to strengthen off-campus adolescent and youth sexual and reproductive health services, and is creating a co-management committee composed of students, university providers, and Ministry of Public Health personnel to exchange data and ideas, to adjust activities to meet challenges as they evolve, and to eventually take full ownership of the work.

Experiences with advocacy in Nigeria are shared in Tanzania

There is great concern among advocates in Tanzania that progress towards reaching national health goals will not be sustained without the government’s increased financial commitment to reproductive health and family planning.

Two advocacy trainers affiliated with the Federation of Muslim Women’s Associations in Nigeria (FOMWAN) were in Tanzania earlier this month to lead a four-day experience-sharing workshop for civil society organizations working on issues related to family planning and reproductive health. FOMWAN is an umbrella organization for Muslim women’s organizations that for the last three decades has worked to improve the health, literacy, economic empowerment, and social development of Muslim girls and women in Nigeria.

The workshop was part of the national effort to institute a new approach to advocacy in Tanzania, which is designed to ensure the Government of Tanzania’s investments in family planning and maternal, newborn and child health (MNCH) services have the greatest possible impact.  This effort includes ensuring those advocating  to key stakeholder groups—policymakers, influential and religious leaders, civil society advocates (including the media), and Council Health Management Teams—use language and strategies that will result in increased national and district commitments to contraceptive services, regardless of external funding. Pathfinder International is leading the national effort, with support from E2A through the USAID Tanzania mission and the UK Department for International Development.

Spitfire advocacy

During the workshop, the trainers assisted 22 participants with revising and sharpening their knowledge and advocacy skills. They learned about using the high-impact advocacy tool ‘spitfire,’ which entails six steps related to ensuring strategic decisions, appropriate goals and objectives, the right message and messengers, the right target audience, and accurate measurements of success. The trainers presented their experiences with using the tool in Nigeria, and participants learned new skills through games, role plays, interactive Q&A, PowerPoint presentations, and group work.

Each participant then outlined a work plan that describes how the participant’s organization will apply learning from the workshop. Those individual work plans were tied to the larger national effort led by Pathfinder International with support from E2A. Results from a test administered to participants before and after the workshop revealed that participants had gained a more complex and sophisticated understanding of advocacy.

In addition to strengthening civil society organizations’ ability to successfully advocate for increased support for family planning and reproductive health programs, the workshop networked a range of like-minded civil society organizations from across Tanzania.

Other efforts led by the Pathfinder/E2A team to develop an effective approach to advocacy include:

  • Commissioning a research policy paper on the demographic dividend based on an economic analysis of the situation in Tanzania, which will highlight the impact of rapid population growth on education, employment, the health sector, and the economy.
  • Convening meetings of an established advocacy network of civil society organizations to identify, articulate, and establish consensus on concrete advocacy “asks,” appropriate for each of the four stakeholder groups mentioned above.
  • Holding quarterly forums with family planning/ MNCH advocacy organizations to review successes and setbacks, and to determine ways of addressing the challenges and advancing family planning and MNCH issues.

New bibliography on systematic approaches to scale-up

One of E2A’s core partner organizations, ExpandNet, has compiled a bibliography of articles relevant to systematically scaling up best practices.  The bibliography can be used as a reference document by other organizations focused on scaling up best practices. The bibliography is not meant to be a final list of relevant documents—rather, it is meant to evolve as others offer suggested article additions. Although E2A is a family planning and reproductive health project, the bibliography focuses on a broad range of health interventions scaled up in low- and middle-income countries, primarily over the last decade. For more information or to suggest additional articles for inclusion in the bibliography, please contact Laura Ghiron at Click here to download.