Recent thoughts about PaLM

Sue and I were invited to a meeting at the Royal College of Obstetricians and Gynaecologists about their work in partnership with the Liverpool School of Tropical Medicine and Hygiene and funded by the Department for International Development on a short course delivering essential lifesaving skills to reduce maternal mortality. This made me think yet again about the essential role of sexual and reproductive health care to reduce maternal mortality. It also stimulated thinking about their model of teaching delivery which is very intensive and very expensive. They take out a group of about 6 consultant obstetricians to deliver the course over a 2 week period in developing countries.

I was asked to put together some bullet points to take to the meeting. I think these are relevant to our thinking about the work of PaLM on SRH. I have cut and pasted them below, a lot of them are lifted directly from the UNFPA website.


A continuum of care is needed to help individuals and couples plan their pregnancies and to provide timely antenatal, delivery and postpartum services, including urgent care for complications that arise among women and newborns.

Access to modern contraceptive methods is an essential part of this continuum. It should always be considered as part of programmes to reduce maternal mortality

an estimated 215 million women who want to avoid a pregnancy are not using an effective method of contraception, despite increases in use in recent years;

Women who are poor are much less likely to have access to modern methods of contraception for example in India

Meeting the needs of these 215 million women would mean that unintended pregnancies would drop by more than two- thirds, from 75 million in 2008 to 22 million per year.

Fulfilling unmet need for modern family planning methods would cost $3.6 billion (in 2008 U.S. dollars), in addition to the $3.1 billion spent serving current users of modern methods—for a total of $6.7 billion annually.

Increasing access to modern contraceptive methods includes 4 strategies:

1. Increased contraceptive service delivery

2. Sex and relationships education

3. Capacity building for organizations advocating SRH

4. Training for heath professionals


Training for health professionals in developing countries is increasingly reliant on internet technologies. Access to the internet among health professionals in developing countries is increasing. Training courses can be delivered cost effectively on the internet (see for example the e-learning for health course developed by the FSRH) and there are already a wide range of high quality free training resources available in contraceptive care.

However this factual learning should be developed and reinforced by clinical training to develop clinical and communication skills. Initial research with students attending the Liverpool School of Tropical Medicine and Hygiene showed that health professionals lack practical skills, for example LARC provision.

Clear measureable outcomes of training are important. They can assess level of knowledge of the practitioner or possibly more importantly the quality of care experienced by the client.

Well validated tools have been developed for both types of assessment for example the UNFPA examples of exit interviews with clients attending contraceptive services provide accurate measures of quality of care. Tools for the assessment of competency within the DFSRH of the FSRH or the LoC for intrauterine devices or contraceptive implants are good examples of measures of provider knowledge and skill.

A blog for PaLM

As part of a strategy to maximise online communication for PaLM and all of its partners I am starting a blog.

It is rather tentative as I have not contributed to, let alone authored a blog before, but it might be an opportunity for all of us who are new to this mode of communication to try it out.

I would like everyone involved with PaLM or thinking about being involved with PaLM to be able to contribute.

I think one possible function of the blog is to document the thinking about PaLM that happens between meetings.

I will post a separate summary of PaLM related issues that I have thought about/discussed over the last few days.

Paula