Parallel 7 - Oral Session 4 (057 – 060)

BACKGROUND/OBJECTIVES 
This presentation showcases results from a policy advocacy intervention to clarify and activate guidelines governing women's access to safe abortion in Lagos State, Nigeria. Until 2011, access to safe abortion was governed by a 95-year-old state law that only permitted abortion to save the life of the woman but was updated that year to also allow abortion to protect her physical health. Service providers were still reluctant, however, to do more than offer postabortion care. Through the intervention, stakeholders influenced the Lagos State commissioner of health to require public health facilities to provide safe abortion services to the full extent allowed by law.
MATERIALS AND METHODS
Evaluators used contribution tracing-a technique that links outcomes through a causal chain of events produced by an intervention-to evaluate the intervention, which featured a locally led organization establishing an expert task force to co-create an advocacy video and implement a dissemination strategy. Contribution tracing combines elements of process tracing and Baynesian probability updating to evaluate a well-articulated causal path.
RESULTS
Evaluators confirmed that the intervention influenced the commissioner's decision to issue an official memorandum clarifying the conditions under which medical staff could legally provide an abortion. Evidence supported each step in the articulated causal chain: the commissioner chaired the task force, participated in policy dialogue, was exposed to updated information on safe abortion and the need to educate public health facilities, all leading him to issue a memorandum for that purpose.CONCLUSIONS
Evaluating policy change is difficult yet necessary to help advocates demonstrate the impact of their work and understand which factors influence policy change. Contribution tracing is an important tool; applying it to reproductive health interventions can generate documented policy impacts and help make the case for investing in advocacy activities to strengthen the policy environment for reproductive health.

Background and Objectives: Despite various efforts towards addressing low modern contraceptive use among women in Nigeria, modern contraceptive prevalence rate (mCPR) remains very low, estimated at 18% in 2021. However, much of the literature have generalise modern contraceptive use among all women using age as an explanatory variable. Thus, this study seeks to examine if mCPR differ according to age groups by comparing predictors among young women (15-24 years) with older women (25-34 years). 
Material and Methods: A secondary analysis of the three most recent Nigeria Demographic and Health Survey (NDHS) datasets was performed by pooling the three survey datasets together (2008, 2013, and 2018). Analysis of data from each round of survey was restricted to currently married women living with their partner, had given birth to at least a child last 5 years preceding each survey, not pregnant, not breastfeeding and sexually active last four weeks preceding the survey. The weighted sample size for the study was 9,705 women: (2018=3,714, 2013=3,315 and 2008=2,676). The outcome variable was non-use of modern contraceptive, while binary logistic regression was performed.
Results: the study found differentials in factors associated with non-use of modern contraceptives among young and older married women. Variation in non-use of modern contraceptive among both age groups are pregnancy termination history, autonomy, exposure to family planning messages and husband's desire for more children, which were significant among older women. However, important predictors of non-use of modern contraceptives for both age groups are household wealth, place of residence, region, religion, partners education, knowledge of modern contraceptives and high fertility desire. 
Conclusion: Addressing barriers to modern contraceptive use among young and older women in Nigeria will no doubt requires a rigorous approach and also suggest the need for strategies targeting specific age groups.

Background: Nigeria's modern contraceptive prevalence rate (mCPR) increased from 9.8% (2013) to 12% (2018), however family planning (FP) unmet need high at 19%. To address this, the Federal Ministry of Health (FMOH) led the introduction of new Reproductive Health (RH) commodities in the country. Previous RH product introductions had been largely partner driven and fragmented resulting in inefficient and expensive introductions. in the process leading to expensive and unstable capacity building practices, poor supply planning and availability of commodities and healthcare worker fatigue.
Methods: Clinton Health Access Initiative (CHAI) in 2021 collaborated with the FMOH to conduct a RH landscape assessment in six states: Bauchi, Enugu, Kaduna, Lagos, Rivers, and the FCT to understand the challenges, successes and lessons learnt from previous RH introductions. In addition to in depth review of local and global RH product introduction literature, the assessment spanned both pubic and private sectors utilizing Key Informant Interviews (KIIs) with 23 key decision makers and interviews with FP providers and clients at 50 healthcare facilities.
Results: Lack of national guidelines delineating roles and responsibilities for product introductions, limited stakeholder coordination and need for improved coordination between government and partners. To address this, CHAI is collaborating with the FMOH to develop a national best practice guideline which highlights key steps and roles for RH product introductions. Stronger government ownership and leadership in RH product introduction through the RH Product Introduction and Coordination Mechanism (PICM) which engages partners and ensures alignment in private and public sectors.
Conclusion: The guideline is essential to ensuring seamless product introductions, mitigate poor sequencing of activities which lead to inefficiencies and wastage of resources. It also provides clarity to the roles and responsibilities of various actors for product introduction, strengthening coordination between private and public sector partners which guarantees alignment of goals and strategies and ensure sustainability.

Background
The National Family Planning Dashboard (FPDB) developed in 2014 by the Federal Ministry of Health (FMOH) and Clinton Health Access Initiative (CHAI) is a web-based tool which provides visibility into Family Planning(FP) services, logistics and Human Resource(HR) data within an integrated and user-friendly interface. It triangulates service delivery coverage, healthcare worker (HCW) training data, FP commodity consumption and stock out data across Nigeria. With Nigeria's Contraceptive Prevalence Rate (CPR) currently at 16.6% and a target CPR of 27% by 2030, it is imperative to ensure unrestricted access and availability of quality contraceptives to women and girls. 
Methodology
To improve choice and access to quality contraceptives, Nigeria recently introduced Levoplant and Hormonal Intrauterine Devices (H-IUD) to the current method mix with support from CHAI and other partners. To achieve visibility into the introduction and scaleup process, CHAI is supporting the FMOH with the development of additional modules on the FPDB to monitor the product introduction process. The scope of which includes commodity disaggregation to monitor individual product data thus mirroring the 2019 updates to the National Health Management Information System (NHMIS). 
Results
The FPDB is used by government and partners to track critical product introduction components allowing for visibility into availability and strategic placement of skilled HCWs across the country. The information on HR and consumption data provides valuable insights into FP commodity availability and FP uptake which in turn informs efficient allocation of resources, and provides critical information on existing gaps, facilitating provision of increased equitable access to FP services across the country. 
Conclusion
The FPDB plays a critical role in monitoring product introduction and scale-up as visibility into HR and logistics data enables evidence-based decision making. Availability of HR data provides visibility into service delivery capacity which in turn maximize resources for introduction and scale-up activities.