CCIH 2013 Concurrent Session 2: Birth Spacing, Burundi. Paul Robinson, World Relief


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The presentation addresses the importance of helping communities to reconcile the right of women to prevent unintended pregnancies and the inherent belief that practicing modern contraception is morally wrong. The Child Survival project in Burundi, which integrated birth spacing intervention clearly demonstrates women can be empowered to make decisions about their pregnancies.

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CCIH 2013 Concurrent Session 2: Birth Spacing, Burundi. Paul Robinson, World Relief

  1. 1. BIRTH SPACING: WHAT CAN WE LEARNFROM THE WOMEN OF BURUNDI ?Integrating Family Planning in a Child Survival projectDr. Paul Robinson, MBBS, MTS, MPHDirector, Health and Social Development TeamWorld ReliefCCIH Annual Conference, Arlington, VA June 8, 2013
  2. 2. OBJECTIVE:DISCUSS METHODS AND RESULTS OFINTEGRATING BIRTH SPACING INTERVENTIONSIN A CHILD SURVIVAL PROJECTOutline:• Background & need for birth spacing• Integration of Family Planning in a Child Survival Project• Achievements of FP intervention• Lessons Learned
  3. 3. 198,516peopleserved inKibuyeHealth Distof GitegaProvinceNetwork of2,991communityvolunteers &170 CHWs
  4. 4. REPRODUCTIVE HEALTH NEEDSIN KIBUYE DISTRICT6.4228160510152025TFR (Burundi) CPR (Burundi) CPR(Kibuye/DHS)CPR (Kibuye/CSP)Percent
  5. 5. LOW UPTAKE OF CONTRACEPTIVESLEADS TO HIGH MMR, IMR & GRCPR16%contributestoMMR499 /100,000LBIMR59 /1000 LBPopulationGrowthRate2.4%
  6. 6. DOWNWARD SPIRAL OFREPRODUCTIVE HEALTHReligious & culturalbeliefsLow literacy: 55%Rumors &misinformation Unmet need:53%High TFR, MMR, N/IMR
  7. 7. STRATEGIES FOR IMPROVING RHOUTCOMESCPR = 50.5% (42% modern methods)ServiceDeliveryby CHWsFPPromotionby CGVsProvincialWorkshop
  8. 8. PROVINCIAL WORKSHOPHighlightsOne day workshop coincided with MOH National RH WeekOpening by Governor of Gitega ProvinceParticipants included 7 MPs, 29 church leaders, 21govt.administrative leaders, 7 Ministry of PH officials and USAIDCountry RepresentativeOutcomes = Recommendations Raising legal age of marriage Organizing campaigns for couples on limiting/spacing births Increasing collaborations between health administration andchurches to avoid contradicting messages on RH
  9. 9. FAMILY PLANNING PROMOTION BYCARE GROUP VOLUNTEERS 2,991 CGVs trained on FP messages and methods 120 local community and church leaders trained on FP 50 MOH staff in 11 health centers trained on FP messages,methods and effective client counseling
  11. 11. SERVICE DELIVERY BY COMMUNITYHEALTH WORKERS 170 CHW have been trained on FP importance, methods anddispelling rumors and false alarms Training also included Community Based Distribution ofcontraceptives Additional 100 CGV leaders trained where CHWs did notexist
  12. 12. ProvincialWorkshopLocalWorkshopCommunityHealthWorkers+VolunteersTHETHREE-PRONGEDAPPROACH
  13. 13. WOMEN WITH INCREASED AWARENESS ANDDEMAND FOR FAMILY PLANNING “We go to Kibuye and to Bukirasazi HC to get modernmethods where no one will identify us.” “Convince religious leaders because they present obstaclesto modern methods.” “Sensitize men to facilitate communication with their wives.” “It would be better if our husbands are involved in trainingin order to hear the messages themselves, and not only beinformed by their wives.” Women from all communes confirmed that they know the CGvolunteers; they have been visited by the volunteers in thelast month and received from them FP messages. They knowthe advantages of FP and modern methods available.
  14. 14. CHURCH LEADERS CHANGED THEIR VIEWS ON FP Curates (Parish Priests) of Catholic churches attendedprovincial workshop at Gitega Church leaders attended district and local level meetingsfollowing the provincial workshop Church leaders give FP messages to their congregations A Roman Catholic program teaches natural contraceptionusing Cycle Beads Religious and community leaders requested more training onmodern methods of FP and expressed interest in morecollaboration with the health system
  15. 15. REPRODUCTIVE HEALTH NEEDSIN KIBUYE DISTRICT6.4228160510152025TFR (Burundi) CPR (Burundi) CPR(Kibuye/DHS)CPR (Kibuye/CSP)Percent
  16. 16. INCREASED CONTRACEPTIVE PREVALENCEIN KIBUYE DISTRICT6.41881642051015202530354045TFR (Burundi) CPR (Burundi) CPR(Kibuye/DHS)CPR(Kibuye/CSP)CPR -- FinalKPC(Kibuye/CSP)Percent
  17. 17. INCREASED CONTRACEPTIVEPREVALENCE IN KIBUYE DISTRICT81642500102030405060CPR(Kibuye/DHS)CPR(Kibuye/CSP)CPR -- FinalKPC(Kibuye/CSP)CPR -- Final(All Methods)Percent
  18. 18. LESSONS LEARNED• Supply of contraceptives is essential asawareness and demand are increased throughSocial & Behavior Change interventions• Performance-based financing scheme forCHWs (paid by MOH) contributed to projectachievements• Field staff & volunteers must know how toaddress questions related to side effects ofcontraceptives & rumors
  19. 19. LESSONS LEARNED (CONTD.)• The church is a key factor for change in FP.Church leaders should be trained on modernmethods of contraceptives• Collaboration of volunteers, CHWs, communityleaders, church leaders & health committeeswas essential for project success• The Care Group Model is an effectivestrategy for mobilizing communities throughreaching every household with FP messages &services
  20. 20. CONTRIBUTIONS &ACKNOWLEDGEMENT• Melene Kabadege, MCH RegionalTechnical Advisor, WR Burundi/ Rwanda• Francois Niyitegeka, WR Burundi ProgramManager• JJ Ivaska, Program Development & AccountabilityDirector, WR Burundi• Olga Wollinka, WR HO MCH Specialist• Victoria Graham, Sr. Technical Advisor, Bureau ofGH, USAID