Community Conversation Isiolo County. Photo credit: Adrienne Allison, World Vision.
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.