Togo

Francophone West Africa Adds 3.8 Million Family Planning Users

kseaton — Wed, 09 Jun 2021 16:27:36 +0000

Francophone West Africa Adds 3.8 Million Family Planning Users kseaton June 09, 2021 June 09, 2021

IntraHealth International’s Civil Society for Family Planning (CS4FP) project partnered with nine countries in francophone West Africa to add 3.8 million additional family planning users and doubled the number of women using modern contraceptives in the region.

For the past ten years, CS4FP has been working with strong, high-functioning civil society coalitions, young people, and religious and traditional leaders in Benin, Burkina Faso, Côte d'Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo (Ouagadougou Partnership countries) to collaborate with and advocate to governments to implement their national family planning costed implementation plans (CIPs). The IntraHealth team established and supported national coalitions in all nine Ouagadougou Partnership (OP) countries to unify and strengthen civil society and hold governments accountable for their family planning commitments.

And the project helped build a stronger, more coordinated civil society, which achieved several significant policy changes, including:

Free family planning services in Benin, Mali, Burkina Faso, and Togo.
Integration of comprehensive sexual education in the national curriculum in Côte d’Ivoire, Guinea, Niger, and Mauritania.
Amendment of the national family planning guidelines in all nine countries to allow community-based distribution of contraception.
Partnership with 285 active religious and traditional leaders and 589 youth ambassadors to raise awareness and break down cultural barriers to family planning.
Engagement with religious and traditional leaders and youth ambassadors in developing the CIPs in their respective countries.

The project’s success can be attributed to CS4FP’s efforts to support, coordinate, and strengthen civil society coalitions (and the civil society organizations they worked with), young people, and religious leaders.

Civil Society Organizations (CSOs)

CS4FP organized workshops for CSOs on good governance, advocacy, resource mobilization, and fundraising. The project also secured commitments from CSOs to join or create family planning coalitions and provided small-scale grants for family planning advocacy. As part of this effort, CSO coalitions engaged young people and religious and traditional leaders to help encourage family planning in their communities. They developed a governance charter, mobilized resources, and developed key strategies for the future.

And they mobilized resources to stay sustainable—for each $1 provided by CS4FP, the coalitions raised an additional $5 to support their family planning activities.

Youth Ambassadors

CS4FP worked as advocates with youth ambassador networks in every country to ensure that national family planning plans and policies reflected the needs and wants of young people.

To do this, the project trained young people on family planning, social media, strategic planning for community mobilization, and resource mobilization to encourage sustainability. Youth networks were active on social media and digital messaging platforms and wrote blog posts on the CS4FP website to share their personal experiences with their peers.

Many adult networks implemented campaigns in their communities to raise awareness and share information about youth-focused family planning activities. As part of the information-sharing effort, youth participated in intergenerational dialogues in their countries and built a regional network linked to the CSO coalitions. Young leaders also received small-scale grants for family planning promotion.

Religious and Traditional Leaders

The project also worked with religious and traditional leaders in all nine Ouagadougou Partnership countries to encourage family planning. Organized at regional levels through the Alliance des leaders Religieux et Traditionnels pour la Santé et le Développement en Afrique de l’Ouest (Alliance of Religious and Traditional Leaders for the Health and Development of West Africa) with CS4FP support, religious and traditional leaders in the nine Ouagadougou Partnership countries and Chad worked together to develop their family planning strategic plan for the next three years.

They participated in family planning workshops to discuss religious texts and the intersection of religion and family planning, and to dispel myths and misinformation about reproductive health. They then developed booklets with key family planning supportive messages and received small grants for advocacy and community mobilization.

CS4FP’s support to civil society coalitions, youth ambassadors, and religious and traditional leaders helped these groups to become well-versed in family planning advocacy and resource mobilization and allowed them to take more ownership to ensure their autonomy and continued success.

These actions helped the West Africa region exceed their FP2020 goals, the only region to do so. Now, there is greater unity and better collaboration among civil society organizations, youth, religious leaders, and Ministries of Health, which has led to more and sustainable family planning and reproductive health activities in francophone West Africa.

CS4FP was funded by the William and Flora Hewlett Foundation and the Dutch Government through the Embassy in Benin.

Benin Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo Family Planning & Reproductive Health Community Health Youth Engagement Civil Society for Family Planning

Developing Composite Indicators for Integrated Family Planning; Maternal, Newborn, and Child Health; and Nutrition Services

kmelton — Mon, 04 Jan 2021 22:02:50 +0000

Developing Composite Indicators for Integrated Family Planning; Maternal, Newborn, and Child Health; and Nutrition Services 2020 kmelton January 04, 2021

IntraHealth's INSPiRE project is designed to catalyze a model of integrated service delivery—and associated performance indicators—into national policy and practice in francophone West Africa. This technical brief describes the development of composite indicators of FP/MNCH/N (family planning; maternal, newborn, and child health; and nutrition) integration for the project.

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Countries Benin Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo

Projects INSPiRE

Topics Family Planning & Reproductive Health Maternal, Newborn, & Child Health Nutrition

By Marguerite Ndour, Roy Jacobstein, Sujata Bijou

TCI’s Francophone West Africa Hub Holds Webinar on Improving Access to Family Planning Among Urban Poor

kseaton — Mon, 05 Oct 2020 14:29:23 +0000

TCI’s Francophone West Africa Hub Holds Webinar on Improving Access to Family Planning Among Urban Poor kseaton October 05, 2020 October 05, 2020

More than 70 program managers, government officials, coaches and staff from The Challenge Initiative (TCI) attended a webinar on Sept. 30, to learn about strategies to expand access to family planning among the urban poor in the Francophone West Africa (FWA) region. The webinar, which was presented in French and included English interpretation, kicked off with a brief introduction to TCI from Hawa Talla, TCI’s chief of party in FWA, before participants heard from Maria Ba, director of the Ouagadougou Partnership Coordinating Unit. After celebrating a decade of achievements in family planning in the region, Ba reflected on inequities in the use of modern contraceptive methods among women of reproductive age, highlighting persistent disparities between the poorest and richest quintiles and rural and urban populations. Ba noted promising opportunities to galvanize local governments and implementing partners to expand access to family planning through high-impact approaches, such as free services, postpartum family planning, and youth-friendly services.

The first panelist, Dr. Zombre Sanon Marcella Valérie, pediatrician and director of family health in Burkina Faso, shared her country’s comprehensive policy framework for family planning, which encompasses strategies to tackle demand generation, service delivery and access, commodities, an enabling environment, coordination, and monitoring and evaluation. Dr. Marcella Valérie then described the context of a decentralized system, where capacity to manage health programming has been transferred to municipalities and regions. In Burkina Faso, municipalities have an essential role to play in family planning, specifically in its resourcing, quality improvement for service delivery, and the implementation of high-impact approaches. Before closing, Dr. Marcella Valérie shared examples of how the country has adapted services as part of the nationwide response to COVID-19, including through the adaptation of counseling to address safety during the pandemic while continuing to ensure informed choice family planning counseling.

Participants then heard from Dr. Moukaila Tchagafou, the director of private sector and community engagement from Amplify-FP’s office in Togo. Dr. Tchagafou shared Amplify-FP’s ambitious strategy to reach more than 10 million women with modern contraceptives. Amplify-FP does this by working with the health system to scale high-impact approaches; mobilizing communities, donors and governments to fund FP programs; and ensuring service quality and coordinating with other partners. The project is leveraging task shifting to provide long-acting reversible contraceptives, postpartum family planning, and tailored services for adolescents and youth to reach their needs. Dr. Tchagafou echoed that Amplify-FP has also faced challenges during the COVID-19 pandemic, noting the importance of leveraging community health workers to offer family planning services such as DMPA-SC in homes since many women are hesitant to go to health centers at this time.

Last but not least, participants heard from TCI’s country program manager in Benin, Hugues Gnahoui, who highlighted the challenging context in Francophone West Africa, citing barriers across health systems, as well as the economic, societal, and political levels. Despite these, Gnahoui shared how TCI’s deployment of coaches who work hand-in-hand with key stakeholders from the region’s health systems and municipalities to the community has allowed for the rapid scale up and adaptation of high-impact approaches, including universal referral, special FP days, household mapping, and young transformational leaders, among others. Finally, Gnahoui highlighted the critical role of strengthened collaboration and coordination among family planning and adolescent and youth sexual and reproductive health programs to ensure the sustainable institutionalization of high-impact approaches in Francophone West Africa.

To learn more about how the Ouagadougou Partnership, Amplify-FP, and TCI are partnering with the Burkinabe government and eight others across Francophone West Africa to expand access to family planning among the urban poor, watch the 75-minute webinar. Stay tuned for additional webinars in this series designed to share implementation guidance and how-to tips related to TCI’s high-impact practices.

This article originally appeared on tciurbanhealth.org on October 2, 2020. You can find it here.

Benin Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo Family Planning & Reproductive HealthPhoto courtesy of The Challenge InitiativeThe Challenge Initiative

Marie Ba to Lead Ouagadougou Partnership Coordination Unit

mnathe — Fri, 24 Apr 2020 12:57:55 +0000

Marie Ba to Lead Ouagadougou Partnership Coordination Unit mnathe April 24, 2020 April 24, 2020

Marie Ba is the new director of the Ouagadougou Partnership Coordination Unit.

The Ouagadougou Partnership is a coalition of nine francophone West African countries—Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo—that are working together to expand family planning in the region.

“She is the right leader to guide the coordination unit through 2020 and beyond.”

Ba has been a member of the coordination unit for more than three years, starting as the regional program manager for advocacy and external relations and then moving into the deputy director role last year. Over the past year, she has served as interim director as well as deputy director and has successfully led the team during this transition.

“I am delighted to announce Marie Ba’s appointment,” says Polly Dunford, president and CEO of IntraHealth International, which serves as the coordination unit of the Ouagadougou Partnership. “She is the right leader to guide the coordination unit of the Ouagadougou Partnership through 2020 and beyond.”

Ba has a master’s degree in international development and peace/conflict resolution from the American University, Washington DC, as well as a bachelor’s degree in economics and social sciences from the University of Maryland-College Park. Her extensive experience in the West and Central Africa regions spans the last twelve years and includes building partnerships and managing health programs, program planning and implementation (including communications and advocacy), financial management, and oversight of grants and contracts.

Read more:

Benin Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo Family Planning & Reproductive Health Leadership and Governance AdvocacyMarie Ba has been a member of the coordination unit for more than three years, starting as the regional program manager for advocacy and external relations and then moving into the deputy director role last year. Photo courtesy of the Ouagadougou Partnership.Ouagadougou Partnership Coordination Unit

The Ouagadougou Partnership: An Improbable Success in a Troubled Region

kseaton — Thu, 19 Mar 2020 15:54:56 +0000

The Ouagadougou Partnership: An Improbable Success in a Troubled Region kseaton March 19, 2020

March 19, 2020

The Ouagadougou Partnership in francophone West Africa advances access to family planning for health and development.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

The Ouagadougou Partnership by the numbers: the global impact of the partnership since its 2011 launch. GRAPH from Ouagadougou Partnership/Adapted by J.Bardi/CFR

By focusing on the impact of family planning—often communicated as birth spacing—as a driver of other health and development outcomes, this partnership has generated new momentum and exposed new challenges for regional collaboration and donor engagement. Pape Gaye, president emeritus of IntraHealth International, one of the partners, is a native of Senegal. In our interview, he said he sees this as a central theme for African development: “It’s time for us to start not only touting the value and health benefits of family planning, but also what it’s going to do in terms of development.”

An Ambitious Goal, Exceeded

The nine francophone countries of the sub-region (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional, voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users in 2011. By 2020, more than 3.8 million additional, voluntary users have begun family planning. Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled.

Francophone West Africa had one of the fastest increases in contraceptive use in developing regions.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the sub-region, country-level champions from government and civil society, supported by implementing partners, all prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and the stalled indicators on family planning. This enabled the francophone West African countries to outpace family planning progress in other developing countries, with a fraction of the resources. It is notable that while spending for family planning in the Ouagadougou Partnership countries remains low compared with other regions in the world, voluntary users of modern contraception has risen faster as a percentage than in any other region in the world.

Helping youth directly address their leaders: Mariam Abou Gado, Ouagadougou Partnership Youth Ambassador in Niger, meets with President Issoufou of Niger to discuss recommendations on family planning. PHOTO courtesy of EtriLabs/Yves Tamomo

Inspiration for Creating the Partnership

The Ouagadougou Partnership was launched at a time when the health landscape in francophone West Africa was alarming, accounting for some of the world’s highest maternal, infant, and under-five mortality rates, and reflecting a considerable discrepancy with countries in anglophone Africa. Underlying these data were some of the world’s lowest family planning indicators and highest fertility rates, resulting in some of the world’s fastest growing populations, with Niger alone projected to nearly triple in population by 2050.

When President Barack Obama took office in January 2009, those working on family planning in the U.S. government saw an opportunity to elevate areas of global health that had not been prioritized under President George W. Bush's administration—notably family planning. After much deliberation, USAID decided to join with the William & Flora Hewlett Foundation, the Bill & Melinda Gates Foundation, and the French government to hold a conference in Ouagadougou in February 2011, hosted by the government of Burkina Faso. Some 250 representatives from country delegations, donors, implementing partners, and civil society participated, and the Ouagadougou Partnership was born.

The Ouagadougou Partnership created high level dialogue among elected officials. Here the former ministers of health for Guinea and Burkina Faso meet with former minister of social affairs for Guinea. PHOTO courtesy of EtriLabs/Yves Tamomo

Implementing the Vision and the Way Forward

Several elements have been key to the Ouagadougou Partnership’s success. The first was the development of Costed Implementation Plans, which are multi-year actionable strategies developed by governments to achieve specific family planning goals. These plans provided roadmaps with credible budgets and helped achieve better alignment of resources. The Ouagadougou Partnership also organizes an annual meeting, designed to both reward progress toward reaching the Partnership’s goals and to nudge those lagging behind. A network of national champions from the governments has been essential to driving the partnership forward. And the Ouagadougou Partnership provided space for civil society to engage on family planning and to hold their governments accountable, including religious leaders, a critical element to build support for family planning, and elevating the voices of young people.

The efforts to advance family planning in francophone West Africa face many uphill battles. Rising extremism and terrorism in the Sahel present grave threats to the countries in the region, and is leading some governments to divert resources from the health sector to the military. A central challenge is how to sustain and reinvent the Partnership going forward, and how to keep all the partners engaged, while linking family planning with broader women’s and girls’ empowerment.

Use of modern contraceptives has increased dramatically in Ouagadougou Partnership countries. GRAPH from Ouagadougou Partnership/Adapted by J.Bardi/CFR

The Ouagadougou Partnership is at an inflection point, poised to expand family planning activities and to focus efforts on young people post-2020, while also confronting rising challenges.

This can’t be routine—it’s a daily fight to try to find solutions for women and to listen to them.

The movement is strong and growing, with committed countries and new donors joining the original group, including Canada, the Netherlands, an anonymous donor, and most recently the UK’s Department for International Development, and the Children’s Investment Fund Foundation. Despite the many challenges ahead, the Ouagadougou Partnership has proven a powerful concept—that by joining together, a group of relatively small and marginalized countries with many barriers to expanding family planning can elevate attention and drive social change. With adaptation and tailoring, the lessons and success factors for this partnership hold promise for other regions of the world. Awa Coll Seck, former minister of health in Senegal, told us in an interview in Dakar: “The best counsel I can give is that this can’t be routine—it’s a daily fight to try to find solutions for women and to listen to them. You have to be convinced of what you do, have all the necessary information, and fight daily to make it happen.”

This article was originally published on Think Global Health on March 18, 2020.

The Ouagadougou Partnership donors meet with President Issoufou of Niger in 2019 after having met the Prime Minister and half of the Niger cabinet as well as the President of the National Assembly. PHOTO courtesy of EtriLabs/Yves Tamomo

By Marie Ba

Director, Ouagadougou Partnership Coordination Unit

By Janet Fleischman

Independent Consultant

Ouagadougou Partnership Coordination Unit Family Planning & Reproductive Health Community Health Policy & Advocacy Youth Engagement Africa Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo

Ouagadougou Partnership Donors' caravan stop at Ecole des Jeunes Filles in Niamey, Niger during a session on "Complete Sexual Education." PHOTO courtesy of EtriLabs/Yves Tamomo

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Young Advocates, Political Will Drive Progress on Family Planning in Francophone West Africa

mnathe — Thu, 05 Dec 2019 20:06:04 +0000

Young Advocates, Political Will Drive Progress on Family Planning in Francophone West Africa mnathe December 05, 2019 December 05, 2019

Countries throughout francophone West Africa are celebrating progress in family planning this week at the Ouagadougou Partnership (OP) annual meeting in Cotonou, Benin, where the theme is We Demand More: Youth and Social Behavior Change.

In 2015, the nine OP countries—Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo—exceeded their initial goal of reaching one million additional individuals with modern contraception and then committed to reaching 2.2 million additional users by the end of 2020. So far, OP leaders announced Tuesday, the countries have achieved 87% of this goal.

In the past year alone, OP countries have added 450,000 users of modern contraception, surpassing their projected figure of 443,000. They estimate that this has prevented 162,000 unwanted pregnancies, 58,000 unsafe abortions, and 560 maternal deaths. The countries have achieved these results in part through social and behavior change approaches that have increased demand for family planning services in the region.

"We are finally seeing sustained momentum in this region."

The OP countries have among the highest maternal, neonatal, and child mortality rates in the world. They also have some of the highest fertility rates. Niger tops the list with an average of seven children per woman.

But since the partnership began in 2011, the OP countries have reached 3.4 million additional women and girls with modern contraception. Key factors in their success this year, leaders said this week, include high levels of political engagement, a dynamic civil society, a growing network of champions, and greater donor interest and investment in the francophone West Africa region.

IntraHealth International, which hosts the Ouagadougou Partnership Coordination Unit, is working throughout the region to boost access to family planning and connect more young people—especially women and girls—to health services that can lead to longer, healthier lives.

"We are finally seeing sustained momentum in this region,” says Pape Gaye, IntraHealth’s president and CEO. “And it’s not just due to one approach or one influx of resources. We’re partnering with multiple donors, young people, community leaders, health workers, government agencies, schools, the private sector—frankly, whoever we can—to help the OP countries maximize returns on family planning investments and develop holistic approaches to make faster, sustained progress in the region.”

Local leadership, local resources

IntraHealth works with mayors and local officials in ten cities—home to 11.7 million people, including 3.1 million women of reproductive age—throughout francophone West Africa through the Challenge Initiative (TCI). These local leaders have committed to boosting family planning and reproductive health services for their populations, including increasing demand for these services, notably among young people—and they’re investing community resources to make it happen.

By the end of its third year, TCI Francophone West Africa Hub had mobilized $423,095 in local contributions.

Also read: President of UCOZ, Benin, Says His Community is Benefitting from the TCI Platform

By the end of its third year (June 2019), TCI Francophone West Africa Hub had mobilized $423,095 in local contributions (both cash and in-kind) and provided messaging to increase awareness of and use of family planning services to 484,000 women of reproductive age. In the past year, 345,000 women have benefited from family planning services in TCI-supported municipalities in Burkina Faso, Benin, Cote d’Ivoire, and Niger. The result: 59,417 new contraceptive users.

Also read: In Six Francophone West African Cities, Mayors Are Serious about Investing in Family Planning

Sex ed & youth advocacy

We’re working to reduce bias in health care, make services friendlier to young people, and get comprehensive information about reproductive health to young people who need it.

We do this in part by developing civil society coalitions—including with local youth ambassadors, religious leaders, women’s groups, and more—through our Strengthening Civil Society Engagement for Family Planning (CS4FP) project. For example, we’re integrating comprehensive sexual education into the high school curricula in Cote d’Ivoire, Guinea, Mauritania, and Niger through a participatory approach, ensuring religious leaders, parents, and students themselves are driving the process.

Community health workers we’ve trained have visited 8,717 young clients in their homes this year.

And because so many of our young colleagues are demanding more comprehensive information and solid advice, they’re not stopping there. A few examples:

In Mali, the coalition’s targeted advocacy messages—including those of youth ambassadors—have helped lead to a new presidential decree establishing free access to family planning services in 2019.
The Niger coalition’s advocacy during a donor group visit in 2019 helped lead to the newly created Family Planning Directorate in Niger, an important step in making funding for family planning a priority in the country. (Also read: Niger Faces Five Key Family Planning Challenges)
In Mauritania, the coalition successfully advocated to include comprehensive sexual education in the national costed implementation plan to reach more youth and adolescents with family planning and reproductive health information.
This summer in Côte d'Ivoire, CS4FP youth ambassadors organized a summer camp in Miandzin, where more than 200 young people ages 15–24 gathered to talk about comprehensive sex ed, reproductive health, and using social media to spread the word.

Also read: This Nigerien Med Student Has a Plan to Tackle Family Planning Taboo

Health worker training for youth-friendly services

This year we’ve trained 60 master trainers and 211 health workers to provide youth-friendly services in Cote d’Ivoire, Guinea, Mauritania, and Niger through CS4FP.

And through our work with TCI, we’ve trained 213 health workers in 137 facilities to provide youth-friendlier services. Community health workers we’ve trained have visited 8,717 adolescents and young people in their homes to provide family planning counseling and referrals.

Now, through INSPiRE, we work in all nine OP countries to help integrate postpartum family planning with nutrition and maternal, neonatal, and child health services. We’ve worked with health facilities in three flagship countries that have become models of excellence for integrating these services. These will serve as training sites for other countries.

INSPiRE has also identified and is working with a local organization, INSP (National Institute of Public Health) in Burkina Faso, to build a foundation for the future of locally driven knowledge-sharing, advocacy, and technical assistance in the region. INSP will serve as a regional hub through the life of the project and beyond.

Also read: New Study Explores Solutions to Postabortion Care Barriers for Young People in Togo

IntraHealth International hosts the Ouagadougou Partnership Coordination Unit, primarily funded by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation. The Challenge Initiative and INSPiRE are funded by the Bill & Melinda Gates Foundation. CS4FP is funded by the William and Flora Hewlett Foundation and the Dutch Embassy.

Benin Burkina Faso Côte d’Ivoire Guinea Mali Mauritania Niger Senegal Togo Family Planning & Reproductive Health Community Health Leadership and Governance Policy & Advocacy Youth EngagementYoung newlyweds in Ouagadougou, Burkina Faso, which is one of the nine countries that make up the Ouagadougou Partnership. Photo by Trevor Snapp for IntraHealth International.Ouagadougou Partnership Coordination Unit

New Study Explores Solutions to Postabortion Care Barriers for Young People in Togo

kseaton — Mon, 16 Sep 2019 15:39:07 +0000

New Study Explores Solutions to Postabortion Care Barriers for Young People in Togo kseaton September 16, 2019 September 16, 2019

Training health workers in Togo is creating higher-quality, youth-friendlier services, resulting in increased usage of modern contraception among young clients. A new article by IntraHealth International’s Stembile Mugore in Global Health Science & Practice explains how training health workers to provide adolescent-friendly postabortion care is increasing voluntary contraception use, reducing unintended pregnancies, and averting abortions and maternal deaths in the country.

This training marks a change for medical services in Togo.

Sixty-one percent of the Togolese population is under 25. For women in that category, the unmet need for contraception is extremely high (42% for ages 15–19 and 40% for ages 20–24), which leads to a higher risk of unwanted pregnancies, illnesses related to pregnancy or childbirth, unsafe abortions, and/or mortality.

Postabortion care includes emergency treatment for abortion complications; access to voluntary family planning services; referrals for other reproductive health services; and community empowerment through community awareness and mobilization. But young women in Togo don’t often seek out such services after an abortion for various reasons, including bias and judgmental attitudes from health workers, parental consent policies, stigma, and social pressure to have children.

Through our work on the Pathfinder International-led Evidence to Action (E2A) project, and in tandem with Togo’s Division for Maternal and Infant Health and Family Planning, health workers were trained at five health facilities from 2014 to 2016 using IntraHealth’s Optimizing Performance and Quality (OPQ) approach.

This approach first identified gaps in care and helped establish solutions to improve youth access to contraception choices. The training module then guided health workers to focus on:

Improving attitudes toward adolescent clients who were interested in contraceptives after having an abortion.
Integrating gender considerations into services.
Developing skills to provide voluntary, adolescent- and youth-friendly family planning counseling and a wide range of contraceptive methods.

After the 14 health workers completed the adolescent focused OPQ training, they treated 351 patients between the ages of 14 and 24 over six months. Of those, 41% chose a modern contraceptive method. Before the training, no young women who had come for postabortion care chose a modern contraceptive after receiving counseling about family planning.

“This training marks a change for medical services in Togo,” says Stembile Mugore. “Now, postabortion care training can be linked to other services, including sexual and gender-based violence, and sexually transmitted infection treatment to help young people access voluntary family planning information and services without fear of provider bias, parental consent, stigma, or societal pressure.”

IntraHealth’s new training module on adolescent postabortion care improved health worker attitudes, reduced bias against contraceptive use for young clients, and enabled these health workers to address sexual and gender-based violence for the first time.

Togo Family Planning & Reproductive Health Education & Performance World Contraception Day Youth Engagement Evidence to Action (E2A) Project

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception

cbishopp — Mon, 28 Jan 2019 15:55:33 +0000

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception 2016 cbishopp January 28, 2019

High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for postabortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions. We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach—IntraHealth International’s Optimizing Performance and Quality (OPQ) approach—was applied at 5 health care facilities in Togo starting in November 2014.

Download

http://www.ghspjournal.org/content/4/3/495#aff-2

Countries Togo

Projects Evidence to Action (E2A) Project

Topics Family Planning & Reproductive Health Maternal, Newborn, & Child Health Health workforce development Quality of Care

Publisher Global Health: Science and Practice

By Stembile Mugore, Ntapi Tchiguiri K Kassouta, Boniface Sebikali, Laurel Lundstrom, Abdulmumin Saad

Why Should Postabortion Care Be Youth-Friendly?

mnathe — Wed, 09 Jan 2019 20:41:58 +0000

Why Should Postabortion Care Be Youth-Friendly? mnathe January 09, 2019

January 09, 2019

Midwife Tembi Mugore answers four questions about bias, shame, and what it takes to overcome them in health services for young people.

At least 8% of maternal deaths worldwide are from unsafe abortions. And almost all abortion-related deaths occur in low- and middle-income countries, mostly in Africa.

“But there is a stigma attached to unsafe abortion, and because of that there is a bias against clients,” says IntraHealth International midwife and public health professional Stembile Mugore. That bias prevents many clients—particularly young ones—from getting the services they need.

I talked with Mugore about her commitment to high-quality reproductive health care and how we can make services better, especially for young people. The following interview has been edited for length and clarity.

[Note: Postabortion care is the term used for a package of services—including medical treatment, counseling, family planning/reproductive health services, and community partnerships—that prevent unwanted pregnancies and unsafe abortions. These services are provided after both induced unsafe abortions and incomplete spontaneous abortions (often called miscarriages).]

Why do you think postabortion care for young people is so important?

Because abortions happen every day, and unsafe abortion is one of the leading causes of maternal mortality. Among young people, there are a lot of misconceptions about abortion, and if it was an unsafe abortion, they are typically unlikely to seek services immediately.

In Togo, for instance, we found that all client records for young unmarried people with no children were coded as self-induced abortions, and that these patients were often seen by health workers as promiscuous, undeserving of pain medication, and happy to have gotten rid of their pregnancy.

Whether their abortion was spontaneous, or if it was unsafe, the only way we can save lives is if they come to seek services. We want to break the cycle of repeat unintended pregnancies and repeat unsafe abortions, and youth-friendly services can address that. They can help young people feel confident coming to a health facility.

What motivates you to do this work?

I am a midwife. I believe that a lot of maternal deaths are preventable and that we could be doing more to stop them. For every woman that dies, there are many more who survive and live with irreversible morbidities: chronic infections, fistula, infertility.

We want to not only improve the quality of services and get more women seeking services early in pregnancy, but also to make sure women receive good care should the pregnancy result in a miscarriage or an incomplete abortion. A lot of young people die because they aren’t able to get those services, whether it’s because they don’t know where to go or because they fear being judged or mistreated, so they wait until the situation is really severe.

A lot of that has to do with the quality of the service that is provided, and how health workers treat those young people. That’s what drives me.

What have been your biggest successes and challenges in doing this work?

My biggest success is changing health worker attitudes. I’m very proud of the work we did in Togo with health workers, and getting to hear them say, “We used to do that, but now we do this.” They were very candid and very open about how they used to provide poor care and how their behavior had changed.

The training we provide instills a sense of empathy and really makes the work personal. When you ask one of those health workers what they would do if the patient was someone they knew—their sister’s child or their brother’s child—you can see the reaction immediately: “Yes it could happen, and yes this person would need help. I would go out of my way to help them.”

I am very aware that behavior change takes a while, and attitude change takes a while, but just from talking with them, there was a change. And for me, that’s a great success.

You need to change the whole culture where services are provided.

But challenges will always remain. When you are creating youth-friendly services, it’s not just about training a certain number of health workers. You need to change the whole culture of everybody working in the area where services are provided—security guards, janitors, record clerks. You don’t want to have a security guard tell a young person, “No, you can’t come in here.”

The person who receives a patient in admission is not likely to be the midwife that you trained, so you need to provide continuous support so that the entire facility is youth-friendly. You need to include everybody.

How can services for young people be done differently?

First and foremost, we need to train more health workers to provide adolescent-friendly services. Whether it’s for family planning, pregnancy care, or postabortion care, we know that young people want services that are anonymous, confidential, and private. It doesn’t work to have them sit on a bench in a waiting room when they’re sitting next to their neighbor or someone who knows their parents.

We also need to make sure that youth have access to all the reproductive health information they need. This includes information about contraception—if they’re sexually active and don’t want to be pregnant, they should be confident they can come and receive services. Age alone should not be a barrier to contraception. We also need to increase awareness around related issues like sexual coercion and what constitutes gender-based violence.

Communication is a key issue here. The communication between health workers and adult clients should look different from communication between health workers and young people. Just because a person is pregnant does not mean that they are mature. They may be only 15 or 16 years old, so they need different care with a lot more sensitivity.

And that comes down to the health worker. You can have youth-focused posters and everything in a clinic, but if the health worker is biased toward young people, those young people will not access the services.

Since 2013, the Evidence to Action (E2A) Project, the US Agency for International Development’s flagship project for strengthening reproductive health and family planning services, has been supporting Togo’s Division of Family Health to offer high-quality postabortion care services that include family planning counseling and access to a range of contraceptives at points of treatment for incomplete abortion to break the cycle of repeat abortions. As a partner in the project, IntraHealth International focuses on gender, capacity building, performance improvement and quality improvement.

By Mallory Michalak

2018 UNC-IntraHealth Summer Fellow

Evidence to Action (E2A) Project Family Planning & Reproductive Health Maternal, Newborn, & Child Health Education & Performance Advocacy IntraHealth-UNC Summer Fellows Quality of Care Youth Engagement Midwives Togo

"Whether it’s for family planning, pregnancy care, or postabortion care," Mugore says, "we know that young people want services that are anonymous, confidential, and private." Photo by Will Boase for IntraHealth International.

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Marguerite Ndour

mnathe — Wed, 06 Jun 2018 19:44:28 +0000

Marguerite Ndour Project director, INSPiRE mnathe June 06, 2018

Marguerite Ndour is a public health professional with more than twenty years of experience leading health promotion projects and programs.

Prior to joining IntraHealth International, she was the Sayana Press program country coordinator at PATH/Senegal, where she provided technical support to the pilot introduction, research, and scale-up of the new generation of injectable contraceptives.

Before joining PATH, Ndour worked at Population Services International/Benin for nine years, including five years as the head of the Reproductive Health Department and four years as advisor on reproductive health to the Minister of Health. In this capacity, she led the development and implementation of integrated programs on reproductive health, family planning, and maternal, neonatal, and child health, funded by the US Agency for International Development and other donors.

For four years, Ndour has worked as an international long-term consultant to the Canadian International Development Agency’s West African AIDS Project Research and Intervention Unit.

Through her years of public health leadership, Ndour has gained considerable experience in organizational development, management, team-building, and program evaluation.

Ndour earned a doctorate in medicine from Dakar’s Universite Cheikh Anta Diop, and a master’s degree in biomedical sciences and public health and a certificate of epidemiology from the Institute of Tropical Medicine in Belgium.

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