“I let others speak about condoms:” Muslim religious leaders’ selective engagement with an NGO-Led family planning project in rural Tanzania

The Danfa Comprehensive Rural Health and Family Planning Project was a joint effort of the Ghana Medical School, the Ministry of Health, UCLA, and USAID. A health education component was developed as an integral part of program inputs during the initial conceptual phase of the project. As a result non-equivalent experimental and control areas were designated permitting an assessment of program impact during a five-year period (1972–1977) for which baseline and follow-up study data were available. A new cadre of community-based workers (Health Education Assistants) was developed from existing health personnel in the country, and trained in health education and multipurpose health work. Although the HEAs were found to have difficulty in bringing about changes in health practices when other support services were not available, they did have measurable impact on villagers' adoption of family planning methods and a number of specific health practices.

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What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

10.21203/rs.3.rs-31442/v4 ◽

2021 ◽

Author(s):

Shari Krishnaratne ◽

Jessie K. Hamon ◽

Jenna Hoyt ◽

Tracey Chantler ◽

Justine Landegger ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Maternal And Child Health ◽

Realist Evaluation ◽

Religious Leaders ◽

Community Members ◽

Theoretical Frameworks ◽

Programme Theory ◽

Integrated Delivery ◽

And Child Health

Abstract Background: Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results: Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

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What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

10.21203/rs.3.rs-31442/v3 ◽

2020 ◽

Author(s):

Shari Krishnaratne ◽

Jessie K. Hamon ◽

Jenna Hoyt ◽

Tracey Chantler ◽

Justine Landegger ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Maternal And Child Health ◽

Realist Evaluation ◽

Religious Leaders ◽

Community Members ◽

Theoretical Frameworks ◽

Programme Theory ◽

Integrated Delivery ◽

And Child Health

Abstract Background:Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods:A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results:Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation.Conclusions:Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

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Powerful Influencers: Kenyan & Zambia Religious Leaders Advocate for Family Planning

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.357 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Bormet

Keyword(s):

Family Planning ◽

Faith Communities ◽

Religious Leaders ◽

Culturally Appropriate ◽

Community Members ◽

Low Literacy ◽

Family Planning Services ◽

Faith Based ◽

A Value ◽

External Stakeholders

Abstract Faith-based organizations (FBOs) provide approximately 40% of healthcare in Kenya and 30% in Zambia. Promoting healthy families is a value at the heart of faith communities. This intervention focused on equipping and encouraging religious leaders (RLs), whose churches own and operate faith-based health facilities, to advocate for family planning (FP) within their congregations, communities, governments. This project included baseline assessments, FP sensitization, and media trainings. Religious leaders were trained through an adaptation of the AFP SMART training by ensuring culturally appropriate messaging for religious audiences were included (i.e. using scripture to discuss and develop messages on families, planning, having children, etc.). Training RLs provides an entree into government fora as culturally respected leaders in positions of power. In order for external advocacy to take place outside of church settings, it is crucial to identify how each church defines FP before meeting with external stakeholders. Creation of low-literacy terms in English and local languages that equipped RLs to interact with community members in-person (i.e. church services, weddings, funerals, community barazas, etc.) and via TV and radio shows was key in addressing myths and misconceptions. Eighty-six religious leaders from 16 denominations in Kenya and Zambia were engaged to sensitize communities and advocate with their Ministries of Health on behalf of the faith community to ensure family planning services reach communities. Equipping RLs in culturally and language appropriate contexts builds stronger advocates for healthy families and communities. Key messages To demonstrate how religious leaders in Kenya and Zambia are equipped to advocate for family planning from a faith perspective. Words and definitions and messengers matter in Family Planning Advocacy from a faith perspective.

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Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

10.21203/rs.3.rs-24210/v3 ◽

2021 ◽

Author(s):

SONIA HAKIZIMANA ◽

Emmanuel Nene Odjidja

Keyword(s):

Family Planning ◽

Cultural Practices ◽

Fertility Rate ◽

Religious Leaders ◽

Community Members ◽

Household Level ◽

Unintended Pregnancies ◽

Negative Beliefs ◽

Contraceptive Prevalence ◽

Desired Family Size

Abstract BackgroundWith a fertility rate of 5.4 children per woman, Burundi has been ranked as seventh highest country with the highest fertility rate in the world. Family planning is known to allow couples to achieve the desired family size, appropriate space birth and the limitation of pregnancies. Also, family planning can contribute to mitigating some health issues such as unintended pregnancies and abortions all of which, are often associated with multi-parity. In conservative community in rural Burundi, knowledge on family planning is high and such services are free yet utilisation is low. Employing a mixed methods, this study first quantifies contraceptive prevalence and second, explore the contextual multilevel factors associated with low family planning utilisation among married women.Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n=132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.ResultsThe overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29, those completed secondary school and having four or less children was significantly associated with use of family planning. Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. ConclusionGiven that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.

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