You can’t scale up alone:

Collaborating with FBOs to expand family planning information and services in Rwanda and the Democratic Republic of the Congo

Marie Mukabatsinda

Institute for Reproductive Health Georgetown University E X P A N D I N G F A M I L Y P L A N N I N G O P T I O N S

• • • •

Objectives:

Demonstrate how FBOs can participate meaningfully in the scale-up of a health innovation Explain how the Standard Days Method family planning ® (SDM) can encourage FBOs to engage in Address challenges to working with FBOs in family planning Offer lessons learned for involving FBOs in family planning

What is the Standard Days Method

®

(SDM)?

• • • • Identifies days 8-19 of the cycle as fertile Is appropriate for women with

menstrual cycles between

26 and 32 days long Helps a couple avoid unplanned pregnancy by knowing which

days they should not have unprotected sex

>95% effective with correct use; 88% effective with typical use

Research-to-Practice with SDM

Method Concept

2000

OR Studies

2003-2005

Pilot Introductions

2000-2004

Method Efficacy

2002

Impact Studies

2005-2007

Scaling-up

2007-2012

1.

2.

3.

4.

5.

10 Reasons to Integrate SDM in Programs

FP methods currently available do not address all unmet need.

SDM addresses user’s concerns, helps fill a critical gap.

When used correctly and consistently—and most users do—SDM is 95% effective.

Adding SDM to the method mix expands choice, increases CPR, and reduces unmet need.

SDM brings new users to FP.

6.

SDM is easy and inexpensive to integrate into programs.

7.

SDM helps bring new partners to the FP field.

8.

SDM improves access to FP because it can easily be offered outside of the health system.

9.

SDM involves men in FP and improves condom counseling.

10.

SDM contributes to women’s empowerment.

• • • •

DR CONGO

Post-conflict, large country with very poor infrastructure Many gaps in health system support by donors 46% of Congolese identify themselves as Catholic, 12% identify as Muslim FBO networks provide 50% of health services • • • •

RWANDA

Strong central & district coordination of health system and system actors FP is part of national development plan 58% of Rwandans identify themselves as Catholic 30% of health services provided by Caritas Distinct physical, political, and social environments yet FBOs provide substantial health services.

trusted FBOs

&

leaders

provide a comfortable entry point to FP for

faith

community members who may not normally seek services “Social mobilization around SDM in our area of influence helped to strengthen our cooperation with religious bodies. At first, they were unforthcoming about our FP services, but now they often help us to mobilize the community, whenever needed.”

Health Center Worker, Rwanda

Rwanda: Caritas

“People thought that the Church wasn’t doing anything—that we just talked about natural methods and didn’t have any results. We are proud of how we work, but we needed to sell our work, to get credible data to the Ministry of Health. At the time, the health information system had no category for natural methods. Through advocacy with the FAM Project, we made that happen. We were able to show data for natural family planning.” (Caritas representative)

Rwanda: Action Familiale

“Since SDM was integrated in our program, training for educators was carried out in little time compared to the time we spent to train providers on self-observation methods. Also, educational tools used in teaching SDM inspired our program to design other improved educational tools. Finally, having a new method in addition to the range of existing natural methods provides our clients with greater choice.” (Action Familiale manager)

DR Congo: L’Action Familiale Conduite de la Fécondité

“IRH invited us to a training session with other organizations that provide hormonal methods of family planning. At first, stereotypes and misconceptions were evident in our interactions, but as the session continued, it became clear that all of us were working towards the same goals, just using different approaches. One by one, I think we all came to realize that if we want to make a positive impact in our country, the most important step is to build a collaborative mindset, not to ensure the implementation of our preferred methods.” (Conduite de la Fécondité manager)

DR Congo: Mamans Ansar

“After attending a training, I decided to preach about family planning, specifically SDM, at the Friday prayer service. It was the first time I had ever talked about a subject like that at the mosque. Considering the sensitivity of faithful Muslims to nuanced topics like family planning that are challenging to explain within an Islamic context, I prepared my presentation carefully. After presenting CycleBeads and describing the advantages of using them, I noticed that everyone was captivated by what I was saying. They were paying close attention to every word!” (Imam, Democratic Republic of the Congo)

• • • • •

Challenges

Many FBOs new to the family planning field and have few linkages with the MOH Overextended providers, facilities with few resources Weak data collection and service statistics reporting Family planning lower priority than HIV/AIDS, malaria, child survival, etc.

Difficulty obtaining commodities

Access to SDM through FBOs and community-based organizations means that women who desire to space or limit their births are able to learn about and receive a family planning method,

some for the first time in their lives.

Lessons learned

1. Not all FBOs are alike 2. Involve FBO leadership in program planning 3. Be flexible and tailor FP materials/language to each partner’s context 4. Design an FP program consistent with the principles of the FBO

Resources

• • • • Biblical Discussion Guide: Love,

children and Family Planning: Seven discussion guides for Christian small groups

SDM training materials for Catholic organizations CycleBeads instructions adapted for Catholic organizations Forecasting guide (CCIH): Getting

Contraceptives to Health Facilities: 10 Questions for Community-Based Groups to Consider

Thank you!

Marie Mukabatsinda

Institute for Reproductive Health Georgetown University