Together for Health logo
Together for Health photo banner showing the USAID logo, the Together for Health wordmark and a young couple and young family receiving family planning information. USAID logo

Our Work

JSI Research & Training Institute, Inc. successfully implemented the Together for Health for the U.S. Agency for International Development from 2005 to 2011. For further information on project activites, visit the TfH page on jsi.com.


Background

Graph of abortion rates per 1000 live births in Ukraine vs. European Union (from WHO/Europe European HFA Database, 2006). Ukraine: 499 per 1000, CIS: 577 per 1000, EU :247 per 1000, Germany: 178 per 1000, Finland: 182 per 1000, Sweden: 340 per 1000, Czech Republic: 240 per 1000.
Graph of abortion rates in Ukraine vs. European Union (from WHO/Europe European HFA Database, 2006).
For many years, abortion and intrauterine devices (IUDs) were the leading methods of birth control in Ukraine. The concept of being able to choose among a broad range of contraceptive methods was unknown to many people. There was widespread distrust of hormonal methods effectiveness and safety, both among health workers and the population, since the primary method available was high-dose oral contraceptives, with significant side effects.

There is now a broad range of contraceptive methods available on the market in Ukraine—at least in cities—contributing to an increasing use of contraception. Nevertheless, there is still widespread concern about modern contraceptive indications and side-effects, as well as the limited number of family planning counseling providers. The 2007 Demographic and Health Survey shows that the Ukrainian fertility rate is 1.2 per woman and that more than half of women who have one abortion will repeat the procedure two to three times across their reproductive lives.

Routine government statistics captured a significant decrease of abortion rates during the last decade. However, the abortion ratio (2007) is about two times higher than the European Union average and the use of hormonal contraception is twelve times lower. Use of traditional methods (withdrawal, calendar methods), on the other hand, are dramatically higher in Ukraine and undoubtedly contribute to the high rates of abortion.

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Strategies

It is against this background that Together for Health works to encourage Ukrainians to adopt family planning practices akin to their European neighbors. The project recognizes that this is a complex task and has adopted a systems approach, built on four main strategies:
Graphical representation of Coordination Across Project Components (the 'FP friendly' services). The relationship is graphically represented as a pyramid. The top point of the pyramid is Population/Clients, the bottom right of the pyramid is Availability of affordable and free contraceptives, and the bottom left of the pyramid is Trained Health Providers. Dotted lines point down from the top of the pyramid connecting the Population/Clients with the two bottom points. A dotted line also connects the two bottom points, Trained Health Providers and Availability of affordable and free contraceptives. The TfH Family Planning logo is in the center of the pyramid, and lines connect it with each of the three points.
Linking the first three strategies is a key challenge for Together for Health. In order to ensure that, at the community level, trained family planning service providers, trained pharmacists who stock a range of affordable contraceptive methods, and an informed population are all in place and aware of each other, the project has developed a conceptual approach represented in the graphic (at right):
  • Trained health workers in primary care settings, women's consultation centers, FP cabinets and hospitals are awarded an "FP friendly" logo to show that they provide high-quality services. Some of these providers carry fully- subsidized contraceptives that are distributed for free to eligible categories of the population;
  • Trained pharmacists who stock this range of affordable contraceptive brands also receive the logo, indicating that contraceptive supplies and informational materials are available; and
  • The logo is promoted through a range of marketing strategies so people will know where to go for contraceptive information, services, and products.

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