Integrating Family Planning with a Maternal and Child Health Program by Initially Reaching Men in Isiolo County, Northeast Kenya
While World Vision was preparing to integrate Healthy Timing and Spacing of Pregnancies and Family Planning (HTSP/FP) within a community-based maternal, newborn, and child health (MNCH) program in Isiolo County, we found that only 8% of women with a child younger than two used contraception even though 77% knew where to get counseling and services. Moreover, 32% had five or more children, and 80% wanted another child within 24 months of their previous birth. This pronatalist society valued large families, as well as large herds of goats and camels, as buffers against adversity in their harsh, semi-arid climate. Furthermore, they distrusted “family planning”—a foreign concept.
As we identified these barriers, we recognized that men were the gatekeepers to their communities: imams influenced men, and men made family fertility decisions about whether and when their many wives would conceive.
Our initial focus was on engaging men by introducing them to a new concept: the health benefits of timing and spacing pregnancies. We trained 71 male and 36 female Community Health Workers (CHWs), 5 Community Health Extension Workers, and several facility-based Ministry of Health (MOH) staff to provide both men and women with friendly, positive counseling on HTSP and the contraceptives that would help them begin to time and space pregnancies to improve the health of women and their children.
We integrated HTSP/FP with MOH antenatal care, and CHWs talked with mothers during their child’s immunizations. CHWs also made household visits to discuss HTSP/FP and began to distribute condoms and pills. Concurrently, we introduced the Standard Days Method and CycleBeads, which proved to be very appealing to men. (In Year One, there were 494 new users; 11% were men who reported they were using the Standard Days Method and CycleBeads.)
We encouraged men to participate in antenatal counseling that included the importance of exclusive breastfeeding followed by contraception to protect a mother from pregnancy until her child was at least two years old.
Male CHWs made remarkable inroads with imams, chiefs, and elders, whom they trained to hold Community Conversations on HTSP. These conversations enabled participants to learn a new vocabulary and new concepts about a previously taboo subject and allowed CHWs to identify and address contraceptive myths and misconceptions.
The leaders warned against early marriage and the risks of teen pregnancies. They also encouraged men and women to space pregnancies by at least two years and to limit pregnancies to a mother’s healthiest years, ages 18 to 34. Imams visited high schools to speak to students about abstinence and protection. Messages about healthy timing and spacing of pregnancies resonate with imams, chiefs, and fathers; they now understand the health and financial benefits that practicing HTSP/FP will bring their communities and families.
Ministry of Health service statistics show that contraceptive uptake is now beginning to rise.
This project is funded to World Vision under Award No AID-OAA-A-12-00047 SUB AWARD # APC-GM-0048, through Advancing Partners & Communities (APC) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning October 1, 2012. APC is implemented by JSI Research & Training Institute, Inc., in collaboration with FHI 360. The project focuses on advancing and supporting community programs that seek to improve the overall health of communities and achieve other health-related impacts, especially in relationship to family planning. APC provides global leadership for community-based programming, executes and manages small- and medium-sized sub-awards, supports procurement reform by preparing awards for execution by USAID, and builds technical capacity of organizations to implement effective programs.
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