Marie Stopes Research Articles

Utilization of social franchising in family planning services: a Pakistan perspective.

Pakistan's private sector caters to around 65% of family planning users. Private sector family planning was promoted in the Delivering Accelerated Family Planning in Pakistan (DAFPAK) program by UK's Foreign, Commonwealth & Development Office (FCDO) in 2019. We use data from DAFPAK to analyze the clientele and products distributed by two major NGOs, Marie Stopes Society (MSS) and DKT Pakistan, that support private providers in Pakistan. We also examined the effect of COVID-19 on client visits and contraceptives uptake at private facilities in Pakistan. DAFPAK used field validation surveys to analyze the volume of clients and products of 639 private facilities across three provinces (Punjab, KPK and Balochistan) of Pakistan. The data was collected in two phases (February 2020 and 2021) using multi-stage cluster sampling at 95% confidence level. Using a generalized negative binomial regression, facility-level characteristics and impact of COVID-19 was analyzed with the volume of clients and products given out at 95% confidence interval alongside descriptive analysis. DKT facilities covered 53% of the sample while MSS covered 47%, with 72% facilities in the rural areas. Average facility existence duration is 87 months (7.25 years). While the average experience of the facility staff is 52 months (4.33 years). MSS is serving more clients as compared to DKT during both phase 1 (IRR: 3.15; 95% CI: 2.74, 3.61) and phase 2 (IRR: 2.11; 95% CI: 1.79, 2.49). Similarly, MSS had a greater volume of products given out in both phases 1 (IRR: 1.89; 95% CI: 1.51, 2.38) and phase 2 (IRR: 2.57; 95% CI: 2.09, 3.14). In both phases, client visits and product distribution decreased when client privacy is invaded (IRR: 0.74; 95% CI: 0.67, 0.82 - phase 1) and (IRR: 0.83; 95% CI: 0.72, 0.97 - phase 2). Lastly, during COVID-19, products distribution decreased by a factor of 0.84 (IRR: 0.84; 95% CI: 0.72, 0.97) but client visits remain unaffected. Overall, clientele is low for all facilities. At a facility, privacy is a determinant of client visits and products given out per visit. Transiently, during COVID-19, client volumes decreased, with a shift from oral pills to condoms and emergency contraceptive pills.

Decadent Dinosaurs: Directed Evolution in British and North American Literature, 1890s–1970s

Despite paying concerted attention to evolutionary mechanisms, literary scholars have rarely focused on forms of “directed evolution” like orthogenesis (evolution along a linear track) and phylogeronty—the parallel between the lifespan of an animal group and the lifespan of an aging individual—analogical concepts reflecting a paleontological manifestation of a wider interest in human decadence. This essay analyzes how these concepts are explored in three areas: popular adventure fiction, social reform novels by Marie Stopes and H. G. Wells, and writings by paleontologists. Across these texts, the essay argues that directed evolution offered a recognizable trajectory with which to render the complexity and strangeness of prehistoric and modern life alike into a familiar linear shape by reading certain extinct animals as moral exemplars of evolutionary failure. While reformers hoped that humans could escape the orthogenetic grooves confining nonhuman animals to extinction, this optimism was shadowed both with fears that humans might inevitably face decadence and with a sense that survival meant mediocrity.

"Friend Beloved, Marie Stopes, Gordon Hewitt, and an Ecology of Letters" edited by L.J. Cameron, 2021 [book review

"Friend Beloved, Marie Stopes, Gordon Hewitt, and an Ecology of Letters" edited by L.J. Cameron, 2021 [book review

Expanding access to early medical abortion services in Ghana with telemedicine: findings from a pilot evaluation.

Abortion in Ghana is legally permissible under certain conditions. Updated in June 2021, the National Comprehensive Abortion Care Services Standards and Protocols included telemedicine as a recognised option for early medical abortion (EMA). Subsequently, Marie Stopes Ghana launched this pilot project to understand the feasibility and acceptability of providing EMA services through telemedicine. The pilot evaluation drew on two research protocols - a process evaluation and a qualitative study. The process evaluation focused on existing routine data sources and additional pilot-specific monitoring, while the qualitative protocol included in-depth interviews with a range of key stakeholders, including telemedicine and in-person patients, healthcare managers, and service providers. Telemedicine for EMA is feasible, acceptable, and has likely expanded access to safe abortion in Ghana. The MSIG telemedicine service package enabled 97% of patients to have a successful EMA at home. Thirty-six per cent of the total 878 patients during the pilot reported that they had no other option for accessing an abortion. Patients described telemedicine EMA services as a highly acceptable and appealing service option. Eighty-four per cent reported they would opt for the telemedicine service again and 83% reported they were very likely to recommend the service. There is potential for telemedicine to expand and improve access to critical SRH services. EMA via telemedicine can be delivered effectively in a low-resource setting. This pilot also showed how telemedicine provides access to patients who feel they do not have other safe service options, meeting specific patient needs in terms of discretion, convenience, and timing.

Assessing the sustainability of two independent voucher-based family planning programs in Pakistan: a 24-months post-intervention evaluation

IntroductionFamily planning vouchers have emerged as a promising approach to improve coverage of underserved groups or underutilized services. The current study was designed to measure the residual/longer-term impact of two-independent FP voucher programs on women’s practices beyond the program’s life program.MethodsA cross-sectional survey conducted, as part of the two-independent larger mixed-method studies, approximately 24 months after the close-down of Marie Stopes Society and Greenstar Social Marketing family planning voucher intervention programs in Punjab, Pakistan. Following necessary ethics approvals, 338 voucher MSS clients & 324 voucher GSM clients were interviewed using a structured questionnaire at the household level.ResultsCompared with end-line data, a significant decrease in the modern contraceptive uptake in both MSS (90% at endline to current (or post-endline) 52%) and GSM (from 84% to current 56%) intervention sites among the voucher clients was noted. Among MSS voucher clients, the highest decline in use was observed in IUCD (54% at endline versus to current 13%); however no change between the surveys was noted among GSM clients. In both projects, following closure of voucher intervention 34% of the discontinued users in MSS and 29% in GSM sites adopted/switched to a new modern contraceptive again. In the post-intervention survey, wealth-based inequality in GSM data depicts more pro-rich utility for modern methods, indicating pro-rich inequality, in contrast, the post-intervention survey in MSS found mixed results such as pro-poor inequality for any method and modern method use.ConclusionsThe prevalence for contraception in two-independent study sites, following closure of voucher intervention remained high than national average. This study provides evidence that family planning vouchers can bring about an enduring positive change in clients’ behaviours in using modern contraceptive methods among poor populations among both intervention models. These results are useful to design family planning programs that will sustain when the donor funding terminates.

There's an App for it: A systematic review of mobile apps providing information about abortion using a revised MARS scale.

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: "would you recommend this app to people who may benefit from it?" Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802).

Natasha Szuhan, The Family Planning Association and Contraceptive Science and Technology in Mid-Twentieth-Century Britain

This is an important and solid study of often under-appreciated aspects of the work from 1930 to 1974 of the major birth control organisation in the UK, the National Birth Control Association, which became the Family Planning Association in 1939. It lacks the dramas we associate with the nineteenth-century pioneers, or Marie Stopes. What it does do is set out the more nuanced and humble history of the association and its members as leaders in medical contraceptive provision, scientific research, application and advocacy, the creation and delivery of education, advice and therapy, and networking and lobbying for the acceptance and oversight of contraception by officials, both medical and governmental. This book adds substantially to our understanding of the work of the NBCA/FPA, the progress of contraception research, the running of clinics and the contribution of various players both internal and external. However, it is rather oddly framed. Szuhan opens by describing three social and scientific theories intersecting at the opening of the twentieth century: ‘Social Darwinism‚ Malthusianism and Eugenics’ and claims that ‘Each supported scientific birth control to address decreasing health and living standards and population concerns’. The founding of the NBCA is said to have been in response to these needs.

Dirty Works: Obscenity on Trial in America’s First Sexual Revolution by Brett Gary

Although the title does not reveal it, Gary’s book employs a biographical approach to the study of how people who embraced modernism challenged the legal gender norms established in the Victorian Age and given potent legal effect through the Comstock Act and similar state legislation. Comstockery was paternalistic in every sense of the word, utilizing the concept of obscenity to protect the moral order of society by regulating sexuality. The legal standard that was used most often to decide obscenity cases was the Hicklin rule, which required only that an object have the potential to corrupt the most susceptible people to be ruled obscene. In the hands of magistrates, customs officials, and postal officials, its use was capricious and extensive.As a cultural historian speaking to legal scholars, political scientists, and legal historians, Gary chronicles the “changes and conflicts around sex and morality in American culture in a booming, ever-expanding marketplace of information and entertainment” from the 1920s into the 1950s (2). He uses “the actions of one particular law firm and one particular lawyer” to show how an older, established fear “of public vulnerability was countered by an equal powerful claim to the public’s right of access” (3). Morris Ernst, a partner at Greenbaum Wolff and Ernst, and associate counsels Alexander Lindey and Harriet Pilpel of the same firm “won signature cases in their larger campaign against” legal suppression of sexual expression and knowledge (3). Representing feminists, birth-control activists, doctors, sex researchers, booksellers, publishers, and novelists, they did a remarkable amount of the heavy lifting required to change the law. Their individual clients included Mary Ware Dennett, the pioneering author of a sex-education manual; Marie Stopes, the author of a path-breaking work extoling women’s sexual pleasure in marriage; Covici and Friede, the American publishers of Radclyffe Hall, author of “the most important English-language lesbian novel” of the period (111); James Joyce, author of the transgressive modernist masterpiece Ulysses; Margaret Sanger, the nation’s foremost birth-control advocate and activist; and Alfred Kinsey, America’s leading sex researcher.Ernst is famous as a leading lawyer for the American Civil Liberties Union (aclu), but, as Gary shows, much of his work took place outside that organization. By shifting the focus away from the organization, Gary sheds new light on how legal and cultural change occurred. His work complements and supplements Leigh Ann Wheeler’s How Sex Became a Civil Liberty (New York, 2012), which explains how the aclu incorporated sexual speech into the freedoms that deserved protection from government. Employing the traditional humanistic methodology of textual analysis, Gary illuminates in great detail how Ernst and his collaborators swayed courts (and sometimes bureaucrats or legislators) to their views. They seldom lost. More than one chapter concludes with the assertion that a judge “rendered a verdict that essentially accepted all their arguments” (286).Gary’s focus is on legal arguments, defense strategies, and trial work—often accompanied by behind-the-scenes maneuvering or publicity campaigns. He treats the briefs as not just legal arguments but also as social and cultural statements, and he views lawyers as creators constrained by the realities of litigation and context. Thus, they downplayed some aspects of their cases to gain a competitive advantage in court. For instance, in defending Dennett they glided past her treatment of masturbation to secure victory, and similarly with Sanger, they strongly pushed for a physicians’ exception to the restriction on importation of contraceptive devises. That decision reinforced the medicalization of birth control.Gary’s work details the emergence of a cultural and legal sexual revolution that set the stage for later developments. Numerous examples show how “Ernst and his colleagues” created “a core body of arguments” deployed “in virtually all of their cases” that “were steadily accepted by the courts,” shifting “the role of the state from one of paternalistic protector of childlike vulnerable citizens to an arbiter of adult marketplaces of knowledge and entertainment” (289).

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions

BackgroundReproductive coercion and abuse (RCA) interferes with a person’s reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors.MethodsData were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person.ResultsRCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting.ConclusionsRCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

Effectiveness and safety of a direct-to-patient telehealth service providing medication abortion targeted at rural and remote populations: Cross-sectional findings from Marie Stopes Australia

ObjectivesWe assessed the safety and effectiveness of direct-to-patient telehealth provision of medication abortion in Australia. Study designWe included all medication abortions (January 2017–December 2018) from Marie Stopes Australia's patient management and adverse event reporting systems. We defined effectiveness as whether the patient had a continuing pregnancy, incomplete abortion, and/or subsequent vacuum aspiration or procedural abortion and safety as whether the patient experienced any adverse event. ResultsDirect-to-patient telehealth was more effective than in-clinic provision (97.2% vs 95.4%). The proportion of adverse events did not differ between groups. ConclusionsThis direct-to-patient telehealth service is safe and effective.

The impact of COVID-19 lockdown on abortion care: a time series analysis of data from Marie Stopes Nepal

The COVID-19 pandemic significantly impacted sexual and reproductive health and rights. Nepal implemented a nationwide lockdown in March 2020, limiting population movement and service access. The 36 clinics run by Marie Stopes Nepal (MSN) closed for varying periods at the beginning of lockdown. This study assesses the impact of lockdown and associated clinic closures on abortion services within MSN’s network. An interrupted time-series analysis of clinic-level MSN data compared abortion service use in the pre-closure and post-reopening periods, focusing on the following outcomes: number of abortion care visits, proportion of abortion-related visits, gestational age at time of abortion care and demographics of patients accessing abortion care. Subsequent meta-analyses combined clinic-level results to generate outcome-specific pooled effect estimates. As MSN clinics reopened, during ongoing wider lockdown, weekly visits for abortion care decreased by 37% on average, but abortion increased as a proportion of services post-reopening (OR: 1.53) compared with pre-closure, with no evidence of a change in the proportion of higher gestation abortions. The demographic profile of abortion care clients was altered, with post-reopening clients more likely to have completed primary education (OR: 1.54) and be aged 25 years or older (OR: 1.31) compared with pre-closure clients. COVID-19 lockdown and associated clinic closures reduced the absolute number of abortion services provided within MSN’s network, impacting the composition of service provision. Reductions in safe abortion and wider SRH access will have wide-ranging consequences, curtailing crucial reproductive rights. Policy-makers must ensure ongoing abortion access to protect rights and ensure access.

The Effectiveness of Delivering Comprehensive Sexuality Education Through Live Streaming to Schools in Western China

Live streaming comprehensive sexuality education (CSE) to rural schools in China’s western region is an innovative program that was implemented by the United Nations Population Fund (UNFPA), Marie Stopes International of China (MSIC), and the Chinese Family Planning Association (CFPA) between September and December 2020. An 8-week CSE course was delivered to 418 Students, grades 7–9, in five middle schools in Western China. The course curriculum applied internationally approved technical standards and was delivered by trained online tutors. An independent research team undertook a curriculum content analysis to evaluate course effectiveness, administered a pre-post students survey, and conducted interviews with students, teachers, and principals. The findings revealed statistically significant positive changes in students’ reproductive and sexual health knowledge (SRH), attitudes, and self-efficacy to make decisions, negotiate, and communicate about sexual matters. Multivariable analysis indicated that the school, gender, and students’ living arrangement were important predictors of outcomes. The study concluded that the pairing of live streaming technology with a comprehensive CSE curriculum is an effective teaching strategy to expand access to CSE to students in remote areas of the country.

An observational study of patient experiences with a direct-to-patient telehealth abortion model in Australia

BackgroundWhile abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma...

From an aviatrix to a eugenicist: walking with Manchester’s Modernist Heroines

This article offers an autoethnographic account of developing a multidisciplinary feminist local history project. In particular it focuses on the construction and delivery of a walking tour celebrating ‘Manchester’s Modernist Heroines’. These were ten women from Greater Manchester, UK, who achieved professional success in the twentieth century. The author evokes ideas of psychogeography and the dérive to produce a tour with collaboration, accessibility and public participation at the heart of its ethos. However the notion of a psychogeographical heritage tour is an oxymoron as the praxis resists essentialist notions of time and space. Additionally, the women featured did not have blue plaques, stately homes or any of the conventional badges of achievement. The focus instead was on resonances, echoes, connections and traces in the everyday landscape. Some, such as Marie Stopes, have a complex and deeply problematic legacy. Geographer Doreen Massey, born in Manchester and one of the subjects, provided inspiration with her progressive vision of space as a simultaneity of ‘stories-so-far.’ The traditional heritage tour became reconfigured as something overtly and proudly performative, participatory and fluid. The route and location contributions are anchored in is mutable, with content evolving as new stories are shared. The walk incorporates education, conversation, art and provocation. This is Feminist public pedagogy which uses the pedestrian to examine issues around commemoration, memory, gender and the right to the city. It utilises embodied creative walking methods to uncover the power dynamics that shape Manchester and offer an alternative way to view them.

Celebrating Women in Paleobotany: A Tribute to Edith L. Taylor—Introduction and Dedication

Celebrating Women in Paleobotany: A Tribute to Edith L. Taylor—Introduction and Dedication

General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision.

In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.

Diary: Abortion in Northern Ireland

Diary:Abortion in Northern Ireland Joanna Biggs (bio) "Diary: Abortion in Northern Ireland" is a nonfiction journalistic piece written by writer and editor Joanna Biggs that was originally published in the London Review of Books on 17 August 2017 and is reproduced here with permission. It provides an account of abortion illegality in Northern Ireland, capturing the tenors and restrictive sinews of the time before the 2019 lifting of restrictions in Northern Ireland. We present it here as a snapshot of this era, with one of the aims of the diary to capture some of the different discursive registers at play, including public and media representations of abortion. Biggs's piece traces the financial, physical, and mental challenges as well as the confrontations and falsities that women in Northern Ireland are forced to face when trying to access reproductive health care and abortion services. It explores the support systems that they can utilize, including the procuring of abortion pills, and she documents some organizations in the United Kingdom that help with financial and practical travel arrangements. In this way the essay functions on a number of important levels at once: as activist journalism calling for the need for widespread abortion services in Northern Ireland; as an informational piece that provides women with some details about abortion options in a restrictive climate and place as a brief historical and contemporary account of the legal and political landscape of Northern Ireland; and as a personal reflection on storytelling and its importance as a transformative device. ________ There is one abortion clinic in Northern Ireland: a Marie Stopes clinic on Great Victoria Street, which joins the two-up two-down red brick terraces of the Lisburn Road, where Ulster banners fly from the lampposts, to the City Hall with its eau-de-nil dome and pale-stone statue of Queen Victoria. The clinic isn't easy to find: the signs beside the door at No. 14 are for BioKinetic Europe, which runs clinical [End Page 232] trials, MKB Law, and Bupa; next door there's a Tesco Express and Boojum, a "Mexican burrito bar." Danielle Roberts, an abortionrights activist with Alliance for Choice, says that on the days the clinic is open—Thursdays and Fridays from 9 a.m. until 6 p.m.—you can't miss it: members of the pressure group Precious Life are always outside. ("We are saving babies, mothers, and indeed this country from the silent holocaust that is brutally destroying fifty million lives worldwide every year.") Danielle acts as an escort for women with appointments on the eighth floor: two activists for every woman, one wearing a "body cam, as there have been assaults and harassment." Abortion, or assisting abortion, is a crime in the United Kingdom: the 1967 Abortion Act that applies in England, Wales, and Scotland gets round this with provisos that allow abortion to be lawfully performed: if the pregnancy is still under twenty-four weeks and two doctors agree that there would be "grave permanent injury" to the "physical or mental health of the pregnant woman," or serious danger to the child. In Northern Ireland, which never adopted the 1967 act, the 1861 Offences against the Person Act—the one that imprisoned Oscar Wilde—substitutes for it. Any pregnant woman "with intent to procure her own miscarriage … shall be guilty of felony … and being convicted thereof shall be liable … to be kept in penal servitude for life" (this remains the maximum penalty). There have been amendments over the years—case law shows that abortion is lawful in Northern Ireland in exceptional circumstances—but nothing to make abortion legal in cases of rape, for instance, has ever been put on the statute book, and successive iterations of medical guidelines haven't made it clear under what conditions doctors would be acting legally (or illegally) when performing an abortion. And there seems to be no political will to make the situation clear: only the Green Party and the People Before Profit Alliance support decriminalization; Sinn Fein wants "limited reform"; but the Alliance Party claim abortion is a matter of individual conscience and the DUP are openly pro-life. To make things worse...

Keeping up with the medical abortion revolution: The Marie Stopes International abortifacient quality assurance system.

Historically, abortion has been a taboo subject; however, there is increasing evidence of a global shift from surgical abortion to medical abortion (MA). Service provision, drug sales, and post-abortion care data suggest that mifepristone and misoprostol pills are increasingly being purchased from pharmacies across the globe, allowing people seeking abortions to start the MA process at a time and in an environment that suits them.

Private Providers' Experiences Implementing a Package of Interventions to Improve Quality of Care in Kenya: Findings From a Qualitative Evaluation.

Quality of care is an important element in health care service delivery in low- and middle-income countries. Innovative strategies are critical to ensure that private providers implement quality of care interventions. We explored private providers' experiences implementing a package of interventions intended to improve the quality of care in small and medium-sized private health facilities in Kenya. Data were collected as part of the qualitative evaluation of the African Health Markets for Equity (AHME) program in Kenya between June and July 2018. Private providers were purposively selected from 2 social franchise networks participating in AHME: the Amua network run by Marie Stopes Kenya and the Tunza network run by Population Services Kenya. Individual interviews (N=47) were conducted with providers to learn about their experiences with a package of interventions that included social franchising, SafeCare (a quality improvement program), National Hospital Insurance Fund (NHIF) accreditation assistance, and business support. Private providers felt they benefited from trainings in clinical methods and quality improvement offered through AHME. Providers especially appreciated the mentorship and guidelines offered through programs like social franchising and SafeCare, and those who received support for NHIF accreditation felt they were able to offer higher quality services after going through this process. However, quality improvement was sometimes prohibitively expensive for private providers in smaller facilities that already realize relatively low revenue and the NHIF accreditation process was difficult to navigate without the help of the AHME partners due to complexity and a lack of transparency. Our findings suggest that engaging private providers in a comprehensive package of quality improvement activities is achievable and may be preferable to a simpler program. However, further research that looks at the implications for cost and return on investment is required.

User Acceptance of Electronic Medical Record System: Implementation at Marie Stopes International, Myanmar.

ObjectivesThis study assessed the technical feasibility and aimed to determine the factors influencing intention to use Electronic Medical Records (EMRs) at Marie Stopes International, Myanmar (MSI-M).MethodsA cross-sectional survey was conducted among 112 participants who were working at the clinics and head office of MSI-M. Demographic information, type of office, technical feasibility, information communication technology knowledge, computer usage, and user acceptance towards the proposed system were obtained from the participants.ResultsThe results indicated low health information technology usage and network availability at MSI-M clinics. Positive perception of EMRs was found among the staff members of MSI-M, which was reflected by positive responses regarding perceived usefulness (average score of 4.15), perceived ease of use (average score of 4.03), and intention to use (average score of 4.10) on a 5-point Likert scale. Statistically, staff from the head office expressed less desire to implement an EMR system (odds ratio = 0.07; 95% confidence interval, 0.01–0.97), especially when they do not perceive the usefulness of the system (odds ratio = 5.05; 95% confidence interval, 2.39–10.69).ConclusionsSince health information technology usage and network availability were low in MSI-M, it is important to strengthen the information and communication technology infrastructure and introduce a policy for capacity building at MSI-M. Adequate training and strong leadership support are recommended for the successful initial implementation and sustainability of an EMR system at MSI-M.