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  • FPET is a valuable tool to support

    2019-06-12

    FPET is a valuable tool to support monitoring of SDG 3·7, which calls for universal access to family planning by 2030, albeit with a focus on demand and utilisation rather than access. Nonetheless, subnational geographic projections must be considered in light of some data limitations. Unmarried women are not included, and even among married women, disaggregation by key equity indicators affecting contraceptive use, such as age, wealth, ethnicity, and rural residence, as well as related gender empowerment indicators such as mobility and decision-making control, is not available. Finally, and perhaps most importantly, FPET does not provide a breakdown by type of contraception. New and colleagues note that “the best-performing states or union territories are in the central region of India and the worst performing are in the northeast”. However, central states such as Andhra Pradesh, Maharashta, and Karnataka are also characterised by high rates of female sterilisation (reported by 49–68% of women of childbearing age in these states); less than 3% of women report use of the contraceptive pill, intrauterine device, or injectable contraceptives in these same states. States in the northeast, such as Manipur, Meghalaya, Assam, and Tripura, have some of the lowest proportions of female sterilisation in the country, ranging from 3% to 14%, but also report some of the highest prevalences of pill use (12–26%). These data reveal important state-level variations by type of contraceptive (spacing limiting). Variations in contraceptive type may further change with India\'s expansion in access to intrauterine devices and injectables, and simultaneous curbing of female sterilisation camps because of deaths and a subsequent Supreme Court ruling against their continuation for a neuraminidase inhibitors of 3 years. Despite these caveats and limitations, FPET is a key resource for Ministries of Health to monitor progress and to prioritise and advocate for states, and possibly in a future iteration, for more vulnerable subpopulations based on both social and gender inequities and with consideration of contraceptives by type. The ability to look at key metrics such as demand for family planning satisfied with modern methods broken down by geography and age and decision-making power, as well as contraceptive type, for example, will more concretely highlight subgroups that are in need of more direct programmatic and policy support to improve their health services and outcomes. This more nuanced modelling approach could enable tools such as FPET to have a broader, more effective reach, and to provide even more meaningful information to programme managers, policy makers, and funders. Whether with FPET or any modelling tool, benefits are best obtained in conjunction with other data to verify and interpret findings, as all tools are subject to assumptions that can change or may not consistently hold true across populations. Finally, efforts to model subgroup-specific family planning projections, and to leave no one behind to achieve ambitious and even aspirational targets such as those set in the SDGs, must guard against compromising choice and reproductive autonomy for women, particularly those who are most socially vulnerable. Certainly, India\'s progress on family planning has been impeded by over-reliance on a single method (female sterilisation), with government sterilisation targets implicated in poor quality care and female mortality. With the advent of promising modelling tools like FPET and a SDG agenda focused on disaggregated indicator tracking, care must be taken that choice and rights are not compromised on a course of meeting targets for all.
    Pneumococcus is the leading cause of bacterial infections in human beings and is a major source of mortality and morbidity worldwide. The incidence of pneumococcal diseases in children varies among populations and countries, and differences have been attributed to several factors, including overcrowding, poverty, underlying conditions (such as HIV infection), and genetics. Accumulation of many of these factors in low-income and middle-income countries, particularly those in Africa, accounts for why a large amount of the global burden of pneumococcal diseases and most of the related deaths are in these countries. Therefore, use of a vaccine effective against pneumococcus for children in low-income and middle-income countries is crucial.