Scaling up depot medroxyprogesterone acetate (DMPA): a systematic literature review illustrating the AIDED model

Abstract

BackgroundUse of depot medroxyprogesterone acetate (DMPA), often known by the brand name Depo-Provera, has increased globally, particularly in multiple low- and middle-income countries (LMICs). As a reproductive health technology that has scaled up in diverse contexts, DMPA is an exemplar product innovation with which to illustrate the utility of the AIDED model for scaling up family health innovations.MethodsWe conducted a systematic review of the enabling factors and barriers to scaling up DMPA use in LMICs. We searched 11 electronic databases for academic literature published through January 2013 (n = 284 articles), and grey literature from major health organizations. We applied exclusion criteria to identify relevant articles from peer-reviewed (n = 10) and grey literature (n = 9), extracting data on scale up of DMPA in 13 countries. We then mapped the resulting factors to the five AIDED model components: ASSESS, INNOVATE, DEVELOP, ENGAGE, and DEVOLVE.ResultsThe final sample of sources included studies representing variation in geographies and methodologies. We identified 15 enabling factors and 10 barriers to dissemination, diffusion, scale up, and/or sustainability of DMPA use. The greatest number of factors were mapped to the ASSESS, DEVELOP, and ENGAGE components.ConclusionsFindings offer early empirical support for the AIDED model, and provide insights into scale up of DMPA that may be relevant for other family planning product innovations.

Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study

“…In order to meet the needs of women who wish to postpone or limit their pregnancies, it is important to have targeted interventions to address the fears and concerns caused by menstrual bleeding changes that frequently occur with hormonal methods such as injectables and implants. This is especially important in low-and middle-income countries (LMICs) where the use of injectables is being prompted due to its higher effectiveness level, as compared to oral hormonal pills, and the ability to use the product discretely [27,28]. The universal concern about menstruation in our sample demonstrates the need for improved counseling, before and during use, to educate women about the role of menstruation in reproduction and how hormones impact menstrual patterns [8,12,13].…”

The pitfalls of scaling up evidence-based interventions in health

“…They related to cost-effectiveness, equity, harms, ethics, bottom-up/top-down scaling-up, and the context in which the EBI was scaled up (see Figure 2). To discuss them, we identified 45 scaling-up studies that raised these difficulties, of which 13 were on costeffectiveness estimates or cost-analysis models [22][23][24][25][26][27][28][29][30][31][32][33][34], 14 on equity [35][36][37][38][39][40][41][42][43][44][45][46][47][48], four on harms [16,[49][50][51][52], three on ethics [53][54][55], six on top-down implementation [42,[56][57][58][59][60], and eight on contextual problems [40,43,[61][62][63][64]…”

Do multi-stakeholder platforms work? : contributions of multi-stakeholder platforms to the performance of research for development interventions

“…Network-based stakeholder typology, scaling out, and scaling up The innovation system literature commonly describes the dissemination of the use of innovations among different stakeholder groups as scaling out, whereby innovations developed by livelihood interventions are used in another geographical location (Hermans et al, 2013;Paina and Peters, 2012), or scaling up, whereby innovations are institutionalized and are commonly used at different geographical locations and in different institutional setups (Curry et al, 2013;Franzel et al, 2004;McDonald et al, 2006;Millar and Connell, 2010). Both definitions are based on geographical location, and scaling up also includes an element of institutional embedding.…”