The Drum Beat 816 - Family Planning Dialogue and Debate

• 1.Promoting Healthy Couples' Communication to Improve Reproductive Health Outcomes
  For decades, the FP field has recognised the importance of couples' communication in the voluntary uptake of modern contraceptive methods. Evidence has emerged on the importance of improving the quality of couples' conversations, with a focus on addressing gender inequalities. This High Impact Practice (HIP) brief examines successful social and behaviour change (SBC) efforts to improve healthy couples' communication that have resulted in uptake of modern contraception. Its appendix outlines evidence-informed interventions to increase healthy couple communication for modern contraceptive uptake. [Apr 2022]
  
   
• 2.Applying a Gender Lens to Social Norms, Couple Communication and Decision Making to Increase Modern Contraceptive Use in Ethiopia, a Mixed Methods Study
  by Nandita Kapadia‑Kundu, Habtamu Tamene, Minyahil Ayele, et al.
  This research sought to identify determinants of contraceptive use in 4 regions of Ethiopia and to explore the relationship between social norms, gender-equitable norms, couple communication, and contraceptive use. Among the findings: Gender inequity is evident in couple communication, with men controlling decision making even if women initiated conversations on FP. The study identified 6 micro-processes of couple communication and decision making around FP that can lead to gender inequity, which the researchers say need to be further examined and researched. [Jun 2022]
  
   
• 3.Association of Traditional Marital Practices with Contraceptive Decision-making, Couple Communication, and Method Use among Couples in Rural Maharashtra, India
  by Anvita Dixit, Nicole E. Johns, Mohan Ghule, et al.
  This paper examines the associations between traditional marital practices and contraceptive behaviours among married women aged 18-29 years and their husbands in rural Maharashtra, India. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (adjusted odds ratio (AOR) 1.76, 95% confidence interval (CI) 1.16-2.68) and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Per the researchers, these findings indicate that "when women are the primary decision-makers on who to marry, this facilitates discussion between the couple on their fertility desires, such as the prevention of any unwanted pregnancy and using a modern method of contraception..." [Apr 2022]
  
   
• 4.Understanding Family Planning Outcomes in Northwestern Nigeria: Analysis and Modeling of Social and Behavior Change Factors
  by Paul L. Hutchinson, Udochisom Anaba, Dele Abegunde, et al.
  Women who had ever talked about FP with their husbands were 3 times more likely both to be currently using modern contraception and to intend to start in the next 6 months. This is one finding from a cross-sectional household survey conducted by Breakthrough RESEARCH as baseline for an evaluation of the Breakthrough ACTION/Nigeria project. As the report notes, SBC programmes often try to shift drivers of high fertility through multiple channels, including interpersonal interventions, community-level group activities, and mass and social media. The goal is to assist SBC programmes in tailoring these efforts by focusing not just on contraceptive use/uptake but on intermediate determinants, such as interpersonal communication and social influences. [Jun 2021]
  
   
• 5."Men Can Take Part": Examining Men's Role in Supporting Self-Injectable Contraception in Southern Malawi, a Qualitative Exploration
  by Lucy W. Ruderman, Catherine Packer, Akuzike Zingani, et al.
  The male engagement framework for involving men in reproductive health (RH), which presents men as FP users, supportive partners, and agents of change, is increasingly being incorporated into FP strategies worldwide. This paper applies this framework to data collected during a study that developed and tested a counseling message to introduce subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Malawi. Focus group discussion (FGD) participants viewed women as being even more inclined to use DMPA-SC self-injection if their male partners and/or community leaders encouraged them to do so. To increase men's acceptability of self-injection, participants in one men's FGD suggested that men whose wives self-inject talk to other men about the practice. Men also proposed that male partners of self-injectors disseminate messages to youth, with the aim of shifting norms for future generations. [Aug 2022]
  
   
• 6.Against All Odds: A Mixed-Methods Evaluation of a Behavioral Postpartum Family Planning Intervention in Tigray, Ethiopia
  by Laura Hinson, Elizabeth Anderson, Kesete Berhane, Hailemariam Berhe, Mohamad (Bram) Brooks, et al.
  This mixed-methods evaluation of the Ethiopia iteration of (re)solve (see #9, below) tested the impact of 4 tools: an antenatal care (ANC) planning prompt card, a postpartum FP (PPFP) counseling sheet, a risk referral card, and a home visit tracking log. From April to December 2021, (re)solve implemented the solution set in 7 primary healthcare units that were already working with the United States Agency for International Development (USAID)-funded TRANSFORM: Primary Health Care project. The intervention had a positive non-significant association with contraceptive intention and a statistically significant association outcomes such as modern contraceptive use (AOR 19.4 CI 9.2-41.1). In the context of social and gender norms in this setting that limit women's ability to decide on and use contraception in an equitable manner, a few providers noted how the tools likely helped women start important conversations with their husbands. [Mar 2022]
  
   

• 7.Behavioural Intervention for Adolescent Uptake of Family Planning: A Randomized Controlled Trial, Uganda
  by Sara Flanagan, Arielle Gorstein, Martha Nicholson, Stephanie Bradish, Diana Amanyire, Andrew Gidudu, Francis Aucur, Julius Twesigye, Faith Kyateka, et al.
  To address the behavioural dimensions of adolescent girls' access to FP services in Uganda, ideas42 partnered with MSI Reproductive Choices and Marie Stopes Uganda to explore and to design and test a peer-referral system that formalises word-of-mouth means of advocating for FP and is intended to reduce stigma about contraceptive use and normalise information-sharing among adolescents. This randomised controlled trial (RCT) found a significant effect of the peer-referral intervention on both primary outcomes: average monthly number of visits by adolescents and proportion of total visits by adolescents. [Sep 2021]
  
   
• 8.Tékponon Jikuagou Final Report
  by Susan Igras and Rebecka Lundgren
  Tékponon Jikuagou is an intervention package, grounded in a social network diffusion approach to social change, that sought to alter social and gender norms in support of FP in Benin. This end-of-project report details how the project worked and what its impacts are. Sample finding: Women exposed to select package components (e.g., interpersonal communication in the form of group discussion and influential outreach, as well as radio) were 6-7 times more likely to use a FP method and to meet their FP needs. [2017]
  
   
• 9.A Game, a Passport, and a Poster: Changing Contraceptive Attitudes, Intentions, and Behaviors Among School Girls in Urban Burkina Faso
  by Laura Hinson, Cecelia Angelone, Aicha Tamboura-Diawara, et al.
  With Bill & Melinda Gates Foundation funding, (re)solve collaborators Pathfinder International, Camber Collective, the International Center for Research on Women (ICRW), and ideas42 undertook a 4-stage process in Burkina Faso to address the bottlenecks that influence girls' FP decisions at various points. Implemented in health facilities and schools, the final solution set consisted of a participatory board game, a health passport meant to ease girls' access to health facilities, posters in health facilities that normalised consultations for adolescent girls, and nametags that identified youth-friendly providers. Among intervention-school girls, there was a statistically significant increase in the percentage reporting ever having gone to the health facility for sexual and reproductive health (SRH)-related reasons, from 6.3% to 32.2% (P.001). It is thought that the gameplay and subsequent conversations with facilitators, boosted girls' confidence to visit health centres and ask follow-up questions, which helped reduce misconceptions and fears. [Dec 2020]
  
   
• 10.Use of Digital Media for Family Planning Information by Women and Their Social Networks in Kenya: A Qualitative Study in Peri-urban Nairobi
  by Anja Zinke-Allmang, Rahma Hassan, Amiya Bhatia, Krittika Gorur, Amy Shipow, Concilia Ogolla, Sarah Shirley, Kees Keizer, and Beniamino Cislaghi
  Studies in Kenya point to the role of healthcare providers and key influencers, such as close family and friends, as trusted sources of FP information. As more young people have access to the internet and digital technology in Kenya, healthcare providers have turned to digital media to develop new ways of sharing credible FP information, especially with young people. To contribute to the literature on the opportunities and limits of using digital media to improve access to FP information, this paper draws on social norms theory to explore how young Kenyan women and their social networks use and navigate digital media spaces to find FP information. One finding: Communicating online with informal networks allowed for discreet ways to share FP information that otherwise might not be shared by speaking face to face due to stigma or shyness - or during the COVID-19 pandemic. [Aug 2022]
  
   
• 11.Provider Behavior Change Approaches to Improve Family Planning Services in the Ouagadougou Partnership Countries: A Landscaping Review
  by Kathryn Spielman, Elizabeth Tobey, Martha Silva, and Leanne Dougherty
  From Breakthrough RESEARCH, this landscaping review shares evidence (as of 2020) on the effectiveness of provider behaviour change (PBC) interventions for improving FP services in the Ouagadougou Partnership (OP) countries of Francophone West Africa. One study in the review built the capacity of Malian providers and connected providers to communities for dialogue about power dynamics and the definition of quality services. Community reflections expressed during these meetings were documented and incorporated into plans of action for the providers, who were routinely monitored. There was a reduction in community complaints from 400 in 2016 to 47 in 2018, and, across the intervention period, there were 57,777 new FP users, a majority of whom used long-acting reversible contraceptives. [Feb 2020]
  
   

• 12.It Takes a Village: A Shared Agenda for Social and Behavior Change for Family Planning/Reproductive Health
  While the Sustainable Development Goals, Family Planning 2030, and OP goals all uphold a desire to ensure universal access to FP/RH information and services, it is unclear how major stakeholders can implement SBC programming to meet those goals in a coordinated way. First developed by Breakthrough ACTION in 2019 and refreshed in 2021-2022, this global shared agenda for SBC in FP/RH identifies 5 strategic priorities where coordination and collaboration are most needed. For example, as part of fostering a supportive environment for FP/RH, this agenda calls on stakeholders to integrate gender considerations in SBC for FP/RH programmes across the life course, prioritise equity in SBC for FP/RH programmes, and improve inclusive community engagement around FP/RH. [May 2022]
  
   
• 13.Community and Provider-driven Social Accountability Intervention for Family Planning and Contraceptive Service Provision: Experiences from the Field
  Social accountability, a participatory process through which community members and civil society organisations create social change, have been brought to bear on issues such as limited uptake of FP services. Through such initiatives, community members and civil society can monitor and advocate for better services, given that patients engaging frontline services play a critical role in identifying local challenges in primary health care. Ultimately, the process brings about a series of interrelated changes that can shift attitudes and behaviours and improve the quality of services. Published by the World Health Organization (WHO), this document outlines the key principles used in the Community and Provider-driven Social Accountability Intervention (CaPSAI) Project study, which was a 24-month, mixed-methods, quasi-experimental study across 16 sites in Ghana and Tanzania. [Dec 2021]
  
   
• 14.Improving Access to Quality Family Planning Services in Nepal and Sri Lanka: Insights from a South-South Learning Exchange
  by Rita Kabra, Manjula Danansuriya, Loshan Moonesinghe, et al.
  This paper documents the process and lessons learned from conducting a South-South learning exchange (SSLE) in FP using an online platform. SSLE describes the process when 2 countries in the global South - in this case, Nepal and Sri Lanka - engage in horizontal peer-to-peer learning. Among the impacts: Following the SSLE, Nepal developed an advocacy tool for PPFP and conducted policy dialogue with policymakers and programme managers using the tool. Based on the learning, the Nepal team is expanding facility- and community-based PPFP initiatives. [May 2022]
  
   
• 15.Policy Communication Toolkit
  The Population Reference Bureau (PRB) has trained researchers and advocates to communicate to policy audiences, bringing small groups together to learn how to translate health and FP research into clear and actionable policy messages. Produced by the USAID-funded Policy, Advocacy and Communications Enhanced for Population and Family Planning (PACE) Project, this toolkit includes all the materials PRB uses to train FP, RH, and population researchers, experts, and advocates. The Youth Leaders module was added to the toolkit in 2019 based on the belief that youth are powerful agents of change when armed with effective communication tools and strategies. PACE has trained 79 champions in more than 13 countries, who achieved changes in policies or programmes integrating FP in multisectoral approaches in 5 countries. [2017]
  
   

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