Innovations Target Improved Access to Family Planning and Evidence-Based Information in Ukraine

Use of modern contraception in Ukraine is lower than Europe or U.S. primarily due to providers' mistrust of hormonals. To change this, the USAID-funded Together for Health (TfH) project worked with the Ministry of Health (MOH) since 2005 to (1) expand access to family planning (FP) services, particularly for the poor, through primary care (PC) providers, and (2) build a sustainable system to change providers' FP attitudes and practices through Evidence-Based Medical (EBM) updates. Access to services was limited to obstetricians-gynecologists in urban areas, so TfH worked with the MOH to develop policies, protocols and training to integrate FP into PC offered by family doctors, midwives and others. Through in-service training of 2,600 PC professionals in 13 project regions, the number of access points for FP grew from under 300 to 1,155 (2006-2009.) To reinforce improved provider attitudes and practices, TfH supported institutionalization of FP training in postgraduate medical education and established an innovative system to continuously reach providers with EBM clinical updates. It prepared selected faculty from academia on EBM methodology and helped them develop Critically Appraised Topics (CATs), fact sheets addressing providers' misinformation about contraceptives. Health authorities and contraceptive manufacturers/distributors reached 5,000+ doctors with CATs and contraceptive updates through workshops and detailing visits. As a result, the proportion of health professionals with positive attitudes towards modern contraception increased from 59 to 70%. Ukraine's experience in expanding access to FP using innovative mechanisms of continuous medical education holds out promise of sustainable improvement in providers' attitudes and practices.