With the launch of the Sustainable Development Goals (SDGs) in 2015, global leaders committed to the health and wellbeing of every person on the planet by 2030. With the development of numerous life-saving and life-enhancing innovations, the potential for using science and technology to achieve this goal has never been greater. Yet with far too many innovations there are stark and unacceptable inequities in availability and access. Further, a high proportion of effective interventions are not being put into practice effectively at scale, particularly in low-income and middle-income countries (LMICs) where scalability and sustainability of interventions with quality have been especially challenging.

The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the "how-to" component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the “how-to” component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

In Brief This article provides a synopsis of The Hale Lecture, presented by Dr. Peterson at the Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists, May 6, 2017, San Diego, California.

In Brief This article provides a synopsis of the Howard Taylor Lecture, presented by Dr. Peterson at the XXI FIGO World Congress of Gynecology and Obstetrics, Vancouver, BC, Canada, October 7, 2015.

The rebirth of family planning is well underway and could not be more important or timely, as countries worldwide work towards implementation of international human rights agreements and achievement of the Millennium Development Goals. 1 Horton R Peterson HB The rebirth of family planning. Lancet. 2012; 380: 77 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 2 Cottingham J Germain A Hunt P Use of human rights to meet the unmet need for family planning. Lancet. 2012; 380: 172-180 Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar However, as reported in The Lancet by Alkema and colleagues 3 Alkema L Kantorova V Menozzi C Biddlecom A National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013; 381: 1642-1652 Summary Full Text Full Text PDF PubMed Scopus (362) Google Scholar and, in this issue, by Jacqueline Darroch and Susheela Singh, 4 Darroch JE Singh S Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Lancet. 2013; 381: 1756-1762 Summary Full Text Full Text PDF PubMed Scopus (205) Google Scholar unmet need for modern contraception in the world's poorest countries is still unacceptably high. Meeting this need will not only help individuals and couples to gain the right to contraceptive information and services, 2 Cottingham J Germain A Hunt P Use of human rights to meet the unmet need for family planning. Lancet. 2012; 380: 172-180 Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar but will also improve the health of women, children, and families. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveysAchievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs. Full-Text PDF

Three cheers for the Centers for Disease Control and Prevention (CDC)! As the nation's premier agency for health promotion and disease prevention, CDC has done it again. Long known for its Morbidity and Mortality Weekly Report guidelines on such topics as STD treatment, antitobacco policy and injury prevention, it has ventured into the increasingly complex clinical world (to say nothing of its political implications) of modern contraceptive methods.

London School of Hygiene and Tropical Medicine, London, UK (Prof J Cleland MA); Perinatology Research Branch, Hutzel Women’s Hospital, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI, USA (A Conde-Agudelo MD); Department of Maternal and Child Health, Gillings School of Global Public Health (Prof H Peterson MD), and Department of Obstetrics and Gynecology, School of Medicine (Prof H Peterson), University of North Carolina at Chapel Hill, Rosenau, Chapel Hill, NC, USA; Futures Group, Washington, DC, USA (J Ross PhD); and Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (Prof A Tsui PhD)

In 2010, Ban Ki-moon launched his Global Strategy for Women's and Children's Health, Every Woman, Every Child. After a decade of campaigning by public-health scientists and civil society organisations, maternal, newborn, and child survival had finally been embraced as an emergency that demands unprecedented international action. The health of the child and mother had already been expressed in the Millennium Development Goals (MDGs)—4 and 5, respectively. But until 2010, these goals had been in the shadow of their more fashionable close relation, MDG 6 (covering AIDS, tuberculosis, and malaria). Yet even within the continuum of care across the mother and child, there was one further neglected dimension—reproductive health, which had been excluded from the MDGs when they were first inaugurated in 2000. Maternal deaths averted by contraceptive use: an analysis of 172 countriesNumbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries. Full-Text PDF Global population trends and policy optionsRapid population growth is a threat to wellbeing in the poorest countries, whereas very low fertility increasingly threatens the future welfare of many developed countries. The mapping of global trends in population growth from 2005–10 shows four distinct patterns. Most of the poorest countries, especially in sub-Saharan Africa, are characterised by rapid growth of more than 2% per year. Moderate annual growth of 1–2% is concentrated in large countries, such as India and Indonesia, and across north Africa and western Latin America. Full-Text PDF Contraception and healthIncreasing contraceptive use in developing countries has cut the number of maternal deaths by 40% over the past 20 years, merely by reducing the number of unintended pregnancies. By preventing high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio—the risk of maternal death per 100 000 livebirths—by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfilment of unmet need for contraception. Full-Text PDF Demographic change and carbon dioxide emissionsRelations between demographic change and emissions of the major greenhouse gas carbon dioxide (CO2) have been studied from different perspectives, but most projections of future emissions only partly take demographic influences into account. We review two types of evidence for how CO2 emissions from the use of fossil fuels are affected by demographic factors such as population growth or decline, ageing, urbanisation, and changes in household size. First, empirical analyses of historical trends tend to show that CO2 emissions from energy use respond almost proportionately to changes in population size and that ageing and urbanisation have less than proportional but statistically significant effects. Full-Text PDF The economic consequences of reproductive health and family planningWe consider the evidence for the effect of access to reproductive health services on the achievement of Millennium Development Goals 1, 2, and 3, which aim to eradicate extreme poverty and hunger, achieve universal primary education, and promote gender equality and empower women. At the household level, controlled trials in Matlab, Bangladesh, and Navrongo, Ghana, have shown that increasing access to family planning services reduces fertility and improves birth spacing. In the Matlab study, findings from long-term follow-up showed that women's earnings, assets, and body-mass indexes, and children's schooling and body-mass indexes, substantially improved in areas with improved access to family planning services compared with outcomes in control areas. Full-Text PDF Use of human rights to meet the unmet need for family planningIn this report, we describe how human rights can help to shape laws, policies, programmes, and projects in relation to contraceptive information and services. Applying a human rights perspective and recognising the International Conference on Population and Development and Millennium Development Goal commitments to universal access to reproductive health including family planning, we support measurement of unmet need for family planning that encompasses more groups than has been the case until recently. Full-Text PDF Family planning: a political issueAfter a decade of stagnation, support for family planning might be gaining momentum. Between 1998 and 2009, donor financing for family planning languished (rising only from US$722·8 million to $748·0 million and reaching a low of $393·5 million in 2006), even though total donor funding for global health nearly tripled.1,2 Decreases in fertility and increases in prevalence of contraceptive use in several countries stalled.3 However, since the late 2000s, the Gates Foundation, the UK, and other donors have augmented funding,4–6 and several low-income countries have renewed their efforts to support family planning programmes. Full-Text PDF

Recommendations shaping policies, programs, and practices in global health should be based on the best available science, but how best to achieve this objective is less clear. We describe a new approach developed by the United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development and Research Training in Human Reproduction within the World Health Organization Department of Reproductive Health and Research for addressing key challenges in global reproductive health. This approach leads to new recommendations for accelerating solutions to priority needs in the field and continued improvements in the science base—including the implementation science base—for meeting these needs. The key components of this new cycle for science-driven solutions include: 1) identifying priority needs of the field; 2) creating guidance that meets the needs of the field; 3) identifying research gaps and establishing and funding research priorities; 4) research synthesis and updating of the guidance in a timely fashion; and 5) supporting utilization in countries through systematic introduction of science-driven solutions. There is a synergistic effect when the contributions of the individual components of this cycle are linked. Strong institutional support is required for this collective effort, as is the creation of a team of researchers, practitioners, donors, and implementing agencies with shared responsibilities for its success. This new approach has already made important contributions toward addressing key challenges in family planning and maternal and perinatal health. We believe that it will help bridge the gap between knowledge and action for reproductive health and for global health more broadly.

Symptoms of nausea and vomiting in early pregnancy (NVP) are common among pregnant women, but whether some women are more likely than others to experience these symptoms has not been well established. We examined potential risk factors for NVP symptom severity, timing of onset, and duration. We included 2,407 newly pregnant women who participated in a prospective cohort study on early pregnancy health between 2000 and 2004 in three U.S. cities. Data on NVP and other health information were collected through telephone interviews, early gestation ultrasound, and medical record abstractions. Generalized linear models were used to model possible risk factors for each NVP characteristic. Eighty-nine percent of women had NVP; for 99% of these, symptoms started in the first trimester. None of the characteristics examined were associated with having NVP. Among those with NVP, increasing risk of delayed symptoms onset was associated with advancing maternal age; increased risks were also seen among non-Hispanic Black [Risk ratio (RR) = 4.3, 95% confidence interval (CI): 1.6,11.6] and Hispanic women (RR = 2.3, 95% CI:0.4,11.5). NVP symptoms for multigravidae were more likely to last beyond the first trimester with each additional pregnancy. Most pregnant women experienced NVP. Nearly all of them, regardless of characteristics examined, had symptoms beginning in the first trimester. Maternal age, race/ethnicity, and gravidity were associated with delayed onset and symptoms that persisted into the second trimester.

The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions.CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence.The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions.The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices.

Background The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions. Study Design CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence. Results The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions. Conclusion The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices.

An attitude shift toward ART in developing countries has resulted in attempts exploring low-cost ART suitable to limited resource settings. This is a positive and needed development. Future steps should consider national infertility needs, position of infertility services within comprehensive reproductive health programs, ART surveillance, and equitable access.

In the above article, the sentence on page S67 in the last paragraph of the section 4.3. Breast Cancer that read A large multinational cohort study that followed 78,000 women for 5 years found no difference in rates of breast cancer among Norplant users, users of copper IUDs and women who had undergone sterilization [41] should have read A large, multinational cohort study that enrolled 7977 Norplant users, 6625 copper IUD users, and 1419 women who had undergone sterilization found no differences in rates of breast cancer among the three groups over five years [41].The authors regret any inconvenience or confusion this error may have caused. In the above article, the sentence on page S67 in the last paragraph of the section 4.3. Breast Cancer that read A large multinational cohort study that followed 78,000 women for 5 years found no difference in rates of breast cancer among Norplant users, users of copper IUDs and women who had undergone sterilization [41] should have read A large, multinational cohort study that enrolled 7977 Norplant users, 6625 copper IUD users, and 1419 women who had undergone sterilization found no differences in rates of breast cancer among the three groups over five years [41]. The authors regret any inconvenience or confusion this error may have caused. Neoplasia with use of intrauterine devicesContraceptionVol. 75Issue 6PreviewOne of the mechanisms by which intrauterine devices (IUDs) prevent pregnancy is the creation of a sterile inflammatory response in the endometrium. Additionally, hormone-releasing IUDs or intrauterine systems (IUSs) release progestins or progesterone into the uterus. Both of these mechanisms may affect users' risk for neoplasia. Full-Text PDF

Background Oral contraceptives were introduced almost 50 years ago, and over 100 million women currently use them. Oral contraceptives can reduce the risk of ovarian cancer, but the eventual public-health effects of this reduction will depend on how long the protection lasts after use ceases. We aimed to assess these effects.Methods Individual data for 23 257 women with ovarian cancer (cases) and 87 303 without ovarian cancer (controls) from 45 epidemiological studies in 21 countries were checked and analysed centrally. The relative risk of ovarian cancer in relation to oral contraceptive use was estimated, stratifying by study, age, parity, and hysterectomy.Findings Overall 7308 (31%) cases and 32 717 (37%) controls had ever used oral contraceptives, for average durations among users of 4 . 4 and 5 . 0 years, respectively. The median year of cancer diagnosis was 1993, when cases were aged an average of 56 years. The longer that women had used oral contraceptives, the greater the reduction in ovarian cancer risk (p<0. 0001). This reduction in risk persisted for more than 30 years after oral contraceptive use had ceased but became somewhat attenuated over time the proportional risk reductions per 5 years of use were 29% (95% CI 23-34%) for use that had ceased less than 10 years previously, 19% (14-24%) for use that had ceased 10-19 years previously, and 15% (9-21%) for use that had ceased 20-29 years previously. Use during the 1960s, 1970s, and 1980s was associated with similar proportional risk reductions, although typical oestrogen doses in the 1960s were more than double those in the 1980s. The incidence of mucinous tumours (12% of the total) seemed little affected by oral contraceptives, but otherwise the proportional risk reduction did not vary much between different histological types. In high-income countries, 10 years use of oral contraceptives was estimated to reduce ovarian cancer incidence before age 75 from 1 . 2 to 0 . 8 per 100 users and mortality from 0 . 7 to 0 . 5 per 100; for every 5000 woman-years of use, about two ovarian cancers and one death from the disease before age 75 are prevented.Interpretation Use of oral contraceptives confers long-term protection against ovarian cancer. These findings suggest that oral contraceptives have already prevented some 200000 ovarian cancers and 100000 deaths from the disease, and that over the next few decades the number of cancers prevented will rise to at least 30 000 per year.

To examine the relationship between the use of oral contraceptives and the risk of death from breast cancer.We used interview data from the Cancer and Steroid Hormone Study, linked to cancer registry data from the Surveillance, Epidemiology, and End Results Program, to examine the 15-year survival and prior use of oral contraceptives among 4,292 women aged 20 to 54 years when diagnosed with breast cancer from December 1, 1980, to December 31, 1982. Cox proportional hazard models were used to estimate the relative rate of death from breast cancer by oral contraceptive use.Duration of oral contraceptive use, time since first use, age at first use, and use of specific pill formulations were not associated with survival. For time since last use, the risk of death from breast cancer decreased significantly with increasing time since last use of oral contraceptives, but a consistent gradient effect was not observed. Adjusted hazard ratios ranged from 0.86 to 1.41 and were 1.00 or less for all recency categories except during 13 to 24 months before diagnosis; none was statistically significant. Women who were currently using oral contraceptives had an adjusted hazard ratio of 0.90 (0.68, 1.19).Overall, oral contraceptive use had neither a harmful nor a beneficial effect on breast cancer mortality. The differences between pill users and nonusers were slight, and the risk estimates were usually reduced with confidence limits that nearly always included 1.0.

Background: One of the mechanisms by which intrauterine devices (IUDs) prevent pregnancy is the creation of a sterile inflammatory response in the endometrium. Additionally, hormone-releasing IUDs or intrauterine systems (IUSs) release progestins or progesterone into the uterus. Both of these mechanisms may affect users' risk for neoplasia.Study Design: We searched the PubMed database for studies on IUD use and risk for neoplasia conducted between 1960 and September 2006 and published in all languages. We excluded case reports and case series. For the association between ever using an IUD and risk for endometrial cancer, we conducted a meta-analysis using a Bayesian random-effects model to account for between-study heterogeneity.Results: We found no evidence of increased risk for neoplasia with IUD use. Nine case-control studies and one cohort study found reduced risks for endometrial cancer with having ever used an IUD (pooled adjusted odds ratio=0.6, 95% confidence interval= 0.4-0.7). No trend in associations was observed with characteristics of IUD use, type of IUD and histologic type of cancer. Four case-control studies found no association between IUD use and risk for cervical cancer. One study found no increased incidence of breast cancer among levonorgestrel-releasing IUS users as compared with the general population in Finland. Finally, three studies found no association between IUD use and occurrence of hydatidiform moles or malignant sequelae.Conclusions: Use of an IUD does not appear to increase the risk for neoplasia. While nearly all studies found that IUD use was associated with a decreased risk for endometrial cancer, it remains unclear whether this association is causal. (C) 2007 Elsevier Inc. All rights reserved.