Global Update November 2012

Centers for Disease Control and Prevention (CDC) sent this bulletin at 12/19/2012 01:05 PM EST
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News and What's New from DRH Global Activities

Welcome to the new, occasional update on the global activities of the Division of Reproductive Health at the Centers for Disease Control and Prevention.

IN THIS NEWSLETTER: In the year since the long-standing agreement between CDC’s Division of Reproductive Health (DRH) and the U.S. Agency for International Development (USAID) came to a close, DRH’s global activities have shifted focus away from Reproductive Health Surveys (RHS) to monitoring, evaluation, and surveillance activities, particularly in the area of maternal mortality (which will be described in a future eUpdate). This eUpdate reports on new tools from DRH (the Spanish-language Reproductive Health Survey toolkit, Web-based training on the Reproductive Health Assessment Toolkit, and the CastCost Contraceptive Projection tool), information on recent surveys (the Republic of Georgia, Guinea Bissau), and the close of the USAID/DRH agreement, and DRH sadly notes the passing of survey pioneer and longtime DRH leader and colleague Leo Morris.

Highlights in this Issue

NEW TOOL: Spanish-Language Reproductive Health Survey Toolkit

Drawing on decades of experience conducting population-based surveys in Latin America, DRH has created the Reproductive Health Survey Toolkit. This Toolkit, created under the auspices of the USAID MEASURE project, allows Spanish-speaking survey implementers to produce high quality, internationally-comparable demographic and reproductive health information without external technical assistance. Available only in Spanish, the Toolkit, Paquete de Herramientas para Encuestas de Salud Reproductiva, is a collection of reference materials and software programs in four modules, each focused around a key technical component of the CDC Reproductive Health Surveys:

Model Questionnaire: The basis of the toolkit is an annotated questionnaire designed to capture key data elements for calculating reproductive health indicators. The model questionnaire covers topics that are common to most Reproductive Health Surveys.

Data Entry and Processing: The toolkit provides a completed CSPro program developed for the model questionnaire, along with multimedia documentation and tutorials that provide step-by-step explanations of how to develop a CSPro program for Reproductive Health Surveys. The module also demonstrates how to generate a final data set and documentation.

Sample Design and Analysis Weights: This section of the toolkit is a brief and practical guide to sample design and selection for Reproductive Health Surveys, as well as to designing and applying analysis weights. Accompanying Excel spreadsheets demonstrate these principles very concretely.

Statistical Analysis: The fourth module of the toolkit provides information and online tutorials on analyzing Reproductive Health Survey data using statistical software. The section includes model SPSS programing syntax for calculating key reproductive health indicators.

NEWS: All RHS Reports and Datasets Are Now Available Online

In the course of its 37-year agreement with USAID, CDC/DRH conducted 85 Reproductive Health Surveys (RHS) in 42 countries. The Reproductive Health Survey reports and data, and their predecessor surveys (the Contraceptive Prevalence Surveys and Family Planning/Maternal and Child Health Surveys), can now be accessed via—

The Global Health Data Exchange (survey reports, data sets).
CDC Stacks (survey reports).
IRC’s StatCompiler web site (indicators from many surveys).

Results from the first national Reproductive Health Survey in Russia (2011) will be forthcoming soon.

NEW TOOL: Web-Based Training on the Reproductive Health Assessment Toolkit

With funding from USAID, CDC developed the Reproductive Health Assessment Toolkit for Conflict-Affected Women. The RHA Toolkit is a user-friendly tool containing step-by-step instructions on how to implement a population-based needs assessment in humanitarian emergency settings. It encourages using the data to promote and enhance services—with the ultimate goal of improving the reproductive health of women and their families living in these difficult conditions.

Three self-guided web-based training modules on the RHA Toolkit are now available—

Introduction to RHA Toolkit for Conflict Affected Women—a basic introduction to the RHA Toolkit
Introduction to Data Use—includes steps on interpreting analysis tables, writing a report, and distributing findings
Determining Sampling Methods—includes a step-by-step guide of sampling concepts

NEW TOOL: CastCost, a User-Friendly Contraceptive Projection Tool

Drawing on its many years of experience in both providing contraceptive logistics assistance and conducting population-based reproductive health surveys, CDC/DRH has developed a tool that quickly produces estimates of a country’s or program’s contraceptive supply needs based on survey and other demographic data.

Known as the Contraceptive Forecast and Cost Estimate Spreadsheet, or CastCost, this tool was developed with funding from USAID.

This user-friendly Microsoft Excel tool provides a “ballpark” estimate of quantities of contraceptives that will be needed for the next five years, as well as how much they will cost. CastCost can also be used for—

Making budget projections.
Validating logistics-based contraceptive forecasts.
Determining likely contraceptive needs as part of a Contraceptive Security exercise.
Testing cost and procurement scenarios for different contraceptive method mixes or supply sources (donors or manufacturers).

CastCost can produce projections for the country as a whole or for different sectors (public or private) or for providers (such as International Planned Parenthood affiliates). It is available in English and Spanish.

NEWS: Contraceptive Prevalence and Fertility Up, Abortion Down in The Republic of Georgia

The Georgian Ministry of Labor, Health and Social Affairs, with the technical assistance of CDC/DRH, implemented its third nationally representative Reproductive Health Survey in 2010, collecting demographic and reproductive health data at both the national and regional levels. The first two surveys took place in 1999 and 2005 and provided information on numerous essential health indicators that have been used to track changes in family planning, maternal and child health, and other reproductive health efforts and behaviors. In the course of the fieldwork, more than 13,363 households were visited and 6,292 women of childbearing age were successfully interviewed, yielding a response rate of 99%.

The three surveys show an interesting pattern: contraceptive prevalence increased, the abortion rate declined—and fertility went up (from a total fertility rate of 1.6 in 2005 to 2.0 in 2010). Contraceptive prevalence among married women is now 53% (35% for modern methods).

Financial support for the survey was provided by the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and United States Agency for International Development (USAID).

NEWS: First National Survey in Guinea Bissau

CDC/DRH and UNICEF provided technical assistance on the first reproductive health survey in Guinea-Bissau since the country achieved independence in 1975. This survey was conducted in 2010 by the National Institute of Statistics (INE), with collaboration from the Ministry of Health, Ministry of Women, and international agencies. The importance of this population-based survey was that it provided the Ministry of Health and international donor agencies, for the first time, with representative data at the national and regional level on contraceptive use (including access to services), unplanned pregnancies, maternal and child health, sexual experience, HIV/AIDS, and gender attitudes/domestic violence. This nationwide household survey successfully interviewed 8,435 women 15–49 years of age (93.4% response rate) from March through July 2010.

Total Fertility Rate

All Women: 5.1 births per woman

Urban: 3.7

Rural: 6.3

Contraceptive Prevalence Rate

All Women: 20% (modern methods: 18.6%; traditional methods: 1.8%)

Married Women: 11% (all methods)

IUDs: 4%

Condoms: 3%

Never married: 36% (all methods)

A data use workshop on secondary analysis of the survey in December 2011 provided participants from the Ministry of Health, INE, and the Institute of Public Health (INASA) with in-depth instruction in the use of the RHS data set, providing staff at these organizations in Bissau with the tools and skills to conduct data analyses in the future with minimal outside technical assistance.

Reports and datasets for the Georgia and Guinea Bissau surveys will be made available in the coming months on the Global Health Data Exchange website as part of the Reproductive Health Survey series. Learn more about CDC/DRH’s Reproductive Health Surveys.

NEWS: DRH Provides Scientific Evidence for Award-Winning WHO Publication

In September 2011, the WHO Medical Eligibility Criteria for Contraceptive Use (4th edition) or “MEC,” a global family planning resource published by the World Health Organization, received the first prize award in the Obstetrics and Gynaecology category of the 2011 British Medical Association Book Awards. The MEC is one of the cornerstones of WHO's Family Planning evidence-based guidelines, and gives recommendations on which contraceptive methods can be advised for use by clients, given a particular medical condition. Funded by USAID, CDC’s Division of Reproductive Health (DRH) provides the scientific review and analysis of new research on contraceptive safety and efficacy that WHO uses to update this publication. The next revision of the MEC is scheduled for 2013.

Through a formal adaptation process, DRH has created the United States Medical Eligibility Criteria for Contraceptive Use (USMEC) for U.S. health care professionals. View CDC Expert Video Commentary on Medical Eligibility Criteria for Contraceptive Use.

NEWS: DRH and USAID Conclude Their 37-Year Agreement

Wanda Barfield and Scott Radloff at End of Project event

Dr. Wanda Barfield, director of CDC/DRH and Dr. Scott Radloff, director of USAID's Office of Population and Reproductive Health, celebrate the 37-year agreement at the End of Project event in Washington, DC.

In September 2011, the CDC’s Division of Reproductive Health (DRH) concluded the last in a long-standing series of agreements with USAID’s Office of Population and Reproductive Health. This intra-governmental partnership, through which USAID accessed CDC/DRH’s technical and scientific skills to serve USAID’s family planning and reproductive health programs, began in 1974. Over the 37-year period, DRH collaborated with USAID on numerous reproductive health advances and provided technical assistance to developing countries in the areas of—

Contraceptive logistics.
Reproductive health and other surveys.
Contraceptive safety and effectiveness.
Epidemiological training and research.
Reproductive health of women in refugee, conflict, and other crisis situations.

This partnership contributed substantively to the ability of millions of couples around the world to better plan their childbearing and to protect their health and improve their children’s health through well-spaced pregnancies. Some of the most noteworthy achievements, tools, and publications from this partnership were—

Population-Based Surveys:

CDC/DRH conducted 85 Reproductive Health Surveys in 42 countries. These surveys have informed governments of the health problems and needs in their countries, resulting in increased and improved health services. While conducting the surveys, CDC/DRH trained their counterparts in country to independently conduct surveys and analyze and apply survey findings. CDC/DRH also developed numerous innovations in survey implementation, content, and analysis. The Reproductive Health Survey reports and data, and their predecessor surveys (the Contraceptive Prevalence Surveys and Family Planning/Maternal and Child Health Surveys) can be accessed via—

The Global Health Data Exchange (survey reports, data sets).
CDC Stacks (survey reports).
IRC’s StatCompiler web site (indicators from many surveys).
Reproductive Health Survey Toolkit/ Paquete de Herramientas para Encuestas de Salud Reproductiva (Spanish language only).

Contraceptive Logistics:

CDC/DRH provided contraceptive logistics assistance in 65 countries, leading to improved logistics systems that provide couples with the contraceptives they need where and when they request them. Among CDC/DRH’s logistics contributions—

Developed and distributed basic contraceptive logistics manuals (Family Planning Logistics Management and The Pocket Guide to Managing Contraceptive Supplies).
Developed or popularized contraceptive logistics technologies (such as the Contraceptive Procurement Table), logistics management software, and the CastCost contraceptive projection spreadsheet.
Developed Innovative technologies for assessing and improving the efficiency and flow of clinic services (Patient Flow Analysis).

Reproductive Health Epidemiology:

CDC/DRH’s epidemiological skills have been used to investigate, research, and analyze contraceptive safety and to increase the evidence base for clinical and policy decision making. Among the epidemiological accomplishments of the DRH/USAID partnership are:

Developed a system of continuous scientific review of new research on contraceptive safety and efficacy to provide the World Health Organization with scientific evidence to update its authoritative Four Cornerstones of family planning—
Medical Eligibility Criteria for Contraceptive Use.
Selected Practice Recommendations for Contraceptive Use.
Decision Making Tool for Family Planning Providers and Clients.
Global Handbook for Family Planning Providers.
Trained several hundred health professionals in developing countries in epidemiologic research and research application, thus increasing the science base for health policy decisions.
Developed a series of Reproductive Health Epidemiology manuals and modules—
Module 1: Public Health Surveillance Applied to Reproductive Health.
Module 2: Maternal Health Epidemiology.
Module 3: Reproductive Tract Infections.
Module 4: Questionnaire Design.

Reproductive Health in Refugee and other Displaced Populations:

Drawing on its epidemiologic and survey skills, CDC/DRH designed and disseminated the Reproductive Health Assessment Toolkit for Conflict-Affected Women, a toolkit to help providers of relief assistance to assess the reproductive health status and needs of refugee, internally-displaced, and conflict-affected women. Three self-guided Web-based training modules on the RHA Toolkit are now available.

Closing Ceremonies

Kate Curtis presenting at End of Project

The conclusion of the 37-year series of agreements between USAID and DRH (most recently known as MEASURE CDC) came to a formal close on September 30, 2011, and was celebrated at an End of Project event on September 27, 2011, in Washington, D.C. USAID staff members, as well as other friends and colleagues of the project through the decades, attended the afternoon event.

CDC/DRH staff presented the project’s major achievements, as well as the leading lessons that project staff learned while providing technical assistance in population-based surveys, contraceptive logistics, and reproductive health epidemiology, and the best practices they developed during the almost four decades of the agreement. After an interlude for conversations with friends and colleagues, examining exhibits on the project’s history and achievements, and viewing a video of staff stories of their experiences with the project, the afternoon concluded with a panel of reminiscences by long-time colleagues at USAID and CDC, which helped to bid the long agreement a fond farewell.

IN MEMORIAM: Leo Morris 1935-2012

The public health community—and the Centers for Disease Control and Prevention in particular—lost a highly productive and esteemed colleague in March with the death of Leo Morris, due to esophageal cancer. Leo had worked at CDC for over 50 years, including continuing on as a very active contractor after his “retirement” in 2004. In those years, he worked in 45 countries and made major contributions to public health, particularly in reproductive health in the areas of survey research, family planning, and adolescent health, in Latin America and Eastern Europe.

Leo began his CDC career as an Epidemic Intelligence Service officer in 1959–1962, and went on to work in polio and smallpox eradication, with a 3-year field assignment in Brazil where he developed a life-long love of all things Brazilian. In 1970, he came to the Division of Reproductive Health (then called the Family Planning Evaluation Division), where he spent the rest of his career. He served as assistant chief of the division until 1978. He then became chief of a branch that eventually went through several name changes (but was most commonly known as “Leo’s Branch”) until 2002, when he became a senior advisor to DRH, until his retirement in 2004. Not wanting and not willing to stop doing the work that had been so such a major part of his life, Leo became a contractor immediately after retirement, continuing to make major contributions to DRH’s international surveys until shortly before his death. He continued traveling as part of his survey work until late last year, when he made a trip to Guinea-Bissau to work on that country’s first ever national reproductive health survey.

Leo made an impact not only because he was a skilled demographer and epidemiologist, but also as a wonderful boss and a mentor of colleagues both at CDC and overseas. There are a great number of Leo stories; perhaps the most familiar is relayed here by longtime CDC colleague Howie Goldberg. “Many visitors to Leo’s office were amazed when they first saw it. It boggled the mind to see the seemingly endless, towering stacks of papers, journals, and documents of all kinds fill virtually every flat space in not only his office, but other offices, desks, and tables that he appropriated. It got to the point that Leo routinely did his “work,” i.e., any activity other than meetings and phone calls, in the offices of staff members who were traveling, since there was no space to do so in his office. But, the most amazing thing about it was that Leo seemed to know where to find pretty much any document or piece of paper that he needed in what looked like utter chaos.”

Further information on Leo Morris and his career can be found here.

For more information on the international activities of the Division of Reproductive Health, please contact Assistant Director for Global Activities Howie Goldberg Phone: 770.488.5257; e-mail: hig1@cdc.gov.