Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)

Family Planning Overview Brief

rgoodwin — Thu, 25 Apr 2024 13:49:03 +0000

Family Planning Overview Brief 2024 rgoodwin April 25, 2024 Download

Countries Global

Projects INSPiRE The Challenge Initiative Next Gen Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-East)Ouagadougou Partnership Coordination Unit Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)Civil Society for Family Planning MOMENTUM Safe Surgery in Family Planning and Obstetrics Ingobyi

Topics Family Planning & Reproductive Health

Publisher IntraHealth International

Together We Decide: Using behavioral science to improve postpartum contraceptive uptake

kseaton — Thu, 18 Aug 2022 13:54:21 +0000

Together We Decide: Using behavioral science to improve postpartum contraceptive uptake 2022 kseaton August 18, 2022

IntraHealth International, in partnership with ideas42, implemented the Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap) project, funded by the William and Flora Hewlett Foundation, to address the challenges of PPFP uptake. We implemented the SupCap project within the USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity led by IntraHealth. SupCap employed a behavioral design process to address barriers women and men face in using contraception during the extended postpartum period.

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Countries Uganda

Projects Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)

Topics Family Planning & Reproductive Health

An Interactive Game Helps Men Start Family Planning Conversations in Eastern Uganda

kseaton — Wed, 06 Apr 2022 19:08:19 +0000

An Interactive Game Helps Men Start Family Planning Conversations in Eastern Uganda kseaton April 06, 2022 April 12, 2022

An interactive game for men that focuses on male engagement for family planning and culminates with a child-spacing planning card has increased family planning use in eastern Uganda. Facilitated by village health teams, the game—Together We Decide—is a collaboration between IntraHealth International and ideas42 as part of the Scale-up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services project (SupCap).

The project used behavioral science to design, test, and scale up an intervention that would help increase postpartum contraceptive uptake, improve communication about family planning between couples, and increase knowledge about modern contraceptive methods in eastern Uganda.

In Uganda, 28% of women have an unmet need for family planning. In the eastern region, unmet need is even higher, at 36%. The region has some of the highest fertility rates in the country, ranging from 5.6 children per woman to 7.9 children per woman. During the postpartum period, 41% of women need contraception to space their pregnancy and 27% of women need contraception to limit pregnancy.

SupCap found that the game and planning card led more men to believe that couples should decide contraceptive use together and that modern methods of contraception are good options for spacing children.

Based on these data, SupCap scaled up the intervention in six districts of eastern Uganda, which made a big difference in family planning services. During a five-month period (October 2021 to February 2022), SupCap:

Conducted 4,618 game sessions, reaching 20,576 men.
Distributed 19,271 child-spacing planning cards, 41% of which were returned to a health facility by a man, woman, or couple for counseling on family planning.
Connected clients to 7,434 contraceptive methods.
Contributed to 61.5% of total postpartum family planning uptake in the six project districts.
Helped increase the range of methods clients chose, including a significant increase in women choosing the permanent contraceptive method, bilateral tubal ligations.

One of the key components of the project was the child-spacing planning card, which referred men who played the game to a health facility. The planning cards helped promote family planning conversations between partners and, as a result, women and men came to health facilities together with a plan. Of the clients who brought planning cards to a facility, 94.7% chose a family planning method.

“It’s exciting to see that the project is achieving what it intended to: improving postpartum family planning uptake through male engagement,” says Susan Tino, SupCap project manager. “Registering over 7,000 women who have taken up modern contraceptive methods in just a few health facilities over five months is commendable work by the district, health facility, and project teams.”

Components of "Together We Decide," a game played by male partners of postpartum women and facilitated by local volunteer health teams.

A family planning referral card, which players received after playing Together We Decide.

Keys to success and unexpected outcomes

SupCap worked closely with district health officials, health workers, religious and traditional leaders, and village health teams throughout each stage of the project. Including a wide range of stakeholders from the beginning of the project was crucial to ensuring project buy-in, success, and sustainability.

“We must thank SupCap for this intervention,” says Sister Susan Akora, an assistant district health officer. "Before, we would only see a woman come to the health facility, never the man. Now they come together.”

The project aimed to increase contraceptive uptake and knowledge about contraceptive methods and improve couples’ communication and help inform women of all their available options. For example, facilities in the Pallisa and Amuria Districts saw a significant increase in women opting for the permanent contraceptive method, bilateral tubal ligations. In the Pallisa District, the average number of monthly bilateral tubal ligations increased by 175% and in the Amuria District, the average monthly number increased by 400%.

“We kept struggling to get clients who opted for bilateral tubal ligations, but SupCap made it easier,” says Jenifer Amuge, a midwife at the Gogonyo Health Center III in the Pallisa District.

“The games brought a change. Even those who did not know about bilateral tubal ligations or other methods got the information and understood their importance.”

There were several additional positive outcomes. Over the course of the project, SupCap helped:

Decrease cases of gender-based violence, thanks to the project’s focus on male engagement and increased communication between partners.
Improve postpartum family planning reporting in DHIS2—an open-source software platform for reporting, analyzing, and disseminating data for health projects—by training health workers to document family planning uptake in the health management information system.
Increase demand for contraceptive methods. When stockouts happened in several district facilities, the SupCap team worked with supply chain advisors to redistribute supplies and ensure district health facilities had adequate supplies to meet the increase in demand.
Increase results-based financing funds to districts, thanks to their improvement in family planning indicators.

Resources

Tested Solutions for Engaging Men in Family Planning

Supporting Couples to Make Active Joint Decisions About Childbearing: An interactive game on family size, child spacing, and contraceptives in Uganda

Uganda Family Planning & Reproductive Health Community HealthMen play Together We Decide at Kaserem subcounty in Kapchorwa, Uganda. Photo by Esther Ruth Mbabazi for IntraHealth International.Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)

Tested Solutions for Engaging Men in Family Planning

kmelton — Tue, 23 Nov 2021 20:18:17 +0000

Tested Solutions for Engaging Men in Family Planning 2021 kmelton November 23, 2021

This design primer details the components of the behaviorally informed intervention used in The Scale-up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning & Reproductive Health Services (SupCap) project. Users of the guide will be able to:

implement the game “Together We Decide”: a game for male partners of postpartum women to encourage contraceptive uptake
distribute child spacing planning cards, which are designed to prompt and encourage conversations between couples about child spacing
view text messages sent to health workers to encourage discussions about family planning with male and female clients.

Development of this report was led by ideas42 and produced in partnership with IntraHealth International.

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Countries Uganda

Projects Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)

Topics Family Planning & Reproductive Health

Supporting Couples to Make Active Joint Decisions About Childbearing: An interactive game on family size, child spacing, and contraceptives in Uganda

kmelton — Tue, 23 Nov 2021 20:11:28 +0000

Supporting Couples to Make Active Joint Decisions About Childbearing: An interactive game on family size, child spacing, and contraceptives in Uganda 2021 kmelton November 23, 2021

This brief describes the behavioral science methodology used by The Scale-up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning & Reproductive Health Services (SupCap) project, describing the behavioral barriers identified and the solution package designed to address these barriers.

Development of this report was led by ideas42 and produced in partnership with IntraHealth International.

Download

Countries Uganda

Projects Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)

Topics Family Planning & Reproductive Health

New Game for Ugandan Men Uncovers Behavioral Barriers to Family Planning

mnathe — Wed, 25 Sep 2019 18:02:51 +0000

New Game for Ugandan Men Uncovers Behavioral Barriers to Family Planning mnathe September 25, 2019

September 26, 2019

Researchers hope the game will help more postpartum couples use modern contraceptive methods.

Uganda has a high fertility rate and a declining mortality rate, resulting in rapid population growth. This has led to a dependent population that is not conducive to economic production, savings, investment, or development.

Uganda also has a high unmet need for family planning— according to the 2016 Uganda Demographic Health Survey, an estimated 28-32% of women do not intend to have more children but are not using any contraception. High teenage pregnancy rates and myths around the use of modern contraceptive methods put the lives of mothers and children at risk.

Women who have given birth within two years make up 19% of the population and 69% have an unmet contraception need.

A fresh behavioral science approach engages men in reproductive health matters.

In general, there is low male involvement in reproductive health services across the region, even though men greatly influence the lives of mothers and children in Uganda. Most intervention programs target only women. But this is changing with a fresh behavioral science approach that seeks to engage men in reproductive health matters.

With funding from the Hewlett Foundation and in partnership with ideas42, IntraHealth International conducted a preliminary behavioral study in the RHITES-E-supported districts of Serere, Kibuku, and Kapchorwa to identify the behavioral barriers to contraception that postpartum women and their male partners face. The study found that:

Couples typically do not discuss how many children to have or when to have them.
Couples typically do not discuss whether to use modern contraceptive methods.
Couples decide to have another child because they either underestimate the cost or overweigh specific benefits of having a child.
Couples do not consider modern contraceptive methods because they think their current actions to avoid children are enough.
Men and women do not have a “moment of choice” during visits to health facilities to consider modern contraceptive methods because health workers do not consistently discuss them with clients.
Couples choose not to use modern contraceptive methods because they are afraid of the side effects, including actual side effects (such as heavy bleeding) and perceived side effects (such as cancer).

One of the interventions we designed to address these behavioral barriers is called Together We Decide, an interactive game specifically for men, since they can be either enablers or inhibiters of contraceptive use. The game teaches men ways to keep their families healthy and how to discuss health topics with their partners.

Some of the materials from Together We Decide, including dice, tokens, game boards, baby cards, and playing cards. Photo by George Mwangi at IntraHealth International.

To start, players are divided into groups/households. Each household builds a family and collects wealth during the game.

During the game, the players are prompted to think about the realities of having children with “cost” playing cards that require them to pay for things like school fees and medical bills. With these costs in mind, the men discuss ways they can ensure they have money for all of their children, such as spacing childbirths and keeping mothers and babies healthy.

Here the game is set up for a household, including tokens (wealth) and babies. Photo by George Mwangi at IntraHealth International.

The game ends with households dividing their wealth per child. The household with the most wealth per child wins. The teams then discuss what they learned from the game and what they will share with their partners.

“We had only three children and accumulated enough wealth for each child,” said a player from the winning household.

“You know our culture tells us to have many children,” said one from the losing household. “But now, from this game I have learned that with many children you remain with little money to take care of them. And you end up with debts like we borrowed from the banker.”

“I thought a woman cannot get pregnant before her periods return,” another man said. “But now I have learned that it can happen.”

Sample playing cards. Photo by George Mwangi at IntraHealth International.

The project intends to use this game and other behaviorally informed interventions to address the barriers that inhibit contraception use in the districts where the RHITES-E project works. We hope the research will increase the use of modern contraceptive methods among postpartum couples and improve the health and well-being of women of reproductive age in Eastern Uganda.

By Irene Mirembe

Knowledge management manager, IntraHealth International

By Susan Tino

Project manager, IntraHealth International

Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap) Family Planning & Reproductive Health Community Health World Contraception Day Gender Equality Uganda

Men play Together We Decide during a user test in one of the districts. Photo by Ely McElwee.

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