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FBOs and Research on Family Planning Services in Uganda

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Lauren VanEnk, MPH, Program Officer at the Institute for Reproductive Health at Georgetown University discusses conducting and using research from FBOs on the family planning services they provide in Uganda at the CCIH 2018 conference.

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FBOs and Research on Family Planning Services in Uganda

  1. 1. What does research have to do with it? Lauren VanEnk Institute for Reproductive Health A discussion around conducting and utilizing research with FBOs through the lens of an assessment of family planning services in Uganda
  2. 2. Overview 1. What’s the current status of research about faith and family planning? 2. Why did we conduct a study with FBOs in Uganda and what did it explore? 3. What did we learn about family planning and FBOs in Uganda? 4. What did we learn about doing research with FBOs? 5. What should the future of research look like for faith and family planning?
  3. 3. What published literature exists? • Widmer, et al. The role of faith‐based organizations in maternal and newborn health care in Africa, 2011 • Campbell, O. Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle- income countries, 2015 • Christian Journal for Global Health, Family Planning Supplement, 2017 • Barden-O'Fallon. Availability of family planning services and quality of counseling by faith-based organizations: a three country comparative analysis, 2017 • (Ongoing) IRH study on family planning counseling in Uganda • (Ongoing) IRH study on Transforming Mascilinities, a social norm intervention with protestant churches in DRC
  4. 4. Uganda Protestant Medical Bureau (UPMB) Uganda Catholic Medical Bureau (UCMB) • Belong to a network of private not-for- profit service delivery institutions in Uganda • Provide ~35% of health services and 70% of health training institutions
  5. 5. Research Design Research Objectives: 1. Describe the experience of clients receiving family planning services from UCMB and UPMB facilities from a quality of care perspective. 2. Describe the behavior of new family planning users who receive counseling at UCMB or UPMB facilities. 3. Understand couple perceptions, attitudes, and behaviors related to family planning. Sample: Clients accepting user-directed methods (SDM, TwoDay, injectables, or oral contraceptive pills) Data Sources: • Initiation interview (immediate) • 1st follow-up interview (3m) • 2nd follow-up interview (6m)
  6. 6. 43% 38% 36% 16% Closest facility Provides the best care Offers services needed Received care here in the past Why clients chose faith-based facility FP CLIENTS SEEK SERVICES FROM FBO SITES FOR NUMEROUS REASONS.
  7. 7. RESPONDENTS KNEW THE SITE WAS AFFILIATED WITH THE [CATHOLIC/PROTESTANT] CHURCH n=310 88% 12% Yes No
  8. 8. PREVIOUS METHOD USED BY RESPONDENTS ACCORDING TO CURRENT METHOD 0 25 50 75 100 Standard Days Method (N=186) TwoDay Method (N=66) Contraceptive pill (N=13) Injectables (N=34) PreviousFPmethod Family planning method selected during counseling session No Method Withdrawal Condoms LARCs Injectable Pills FAM
  9. 9. MEASURING QUALITY • Client satisfaction • Does the provider offer client-centered counseling by taking stock of her health & personal history? • Does the provider offer informed choice counseling? • Does the provider offer correct and sufficient information about how to use the method?
  10. 10. MOST CLIENTS ARE SATISFIED WITH FP COUNSELING AT FBO SITES. Catholic n=196 Protestant n=106 33% 54% 57% 41% 9% 3% 1% 3% 1% 0% Catholic Protestant Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied
  11. 11. HEALTH & PERSONAL HISTORY 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Medical history Desire for children in the future Time living with partner Partner's attitude toward FP Previous FP use knowledge of FP methods Interst in a particular method Concerns about FP Responded to concerns Reasons some methods might not be appropriate UCMB UPMB
  12. 12. METHOD INFORMATION INDEX 1) Were you informed about other methods? 2) Were you informed about side effects? 3) Were you told what to do if you experienced side effects? 53%Of clients reported all 3 nationally (UDHS 2015) 83%Of FBO clients reported all 3 (IRH study) V.
  13. 13. INFORMED CHOICE: AVERAGE NUMBER OF METHODS DISCUSSED BY SITE 7.6923 3.4000 7.7083 8.5128 8.1429 7.3871 0 5 10 Site A Site B Site C Site D Site E Site F
  14. 14. INFORMED CHOICE: PRESENTATION OF METHODS 0 25 50 75 100 Presented some methods more favorably Presented some methods less favorably Site A Site B Site C Site D Site E Site F
  15. 15. INFORMATION PROVIDED ABOUT METHOD USE 0 25 50 75 100 How to use method Possible side effects/problems How to deal with side effects/problems Asked to repeat important information Method does not prevent HIV and STIs SDM TWODAY PILL USERS INJECTABLE
  16. 16. CORRECT USE, CONTINUATION & MALE INVOLVEMENT
  17. 17. CORRECT USE OF METHOD SDM N=149 TWODAY N=48 INJECTION N=24 PILL N=8 Abstained or used a condom on fertile days in the past month Abstained or used a condom on fertile days in the past month AND checks secretions at least twice a day Received an injection within 90 days after previous injection Takes a pill once a day, at the same time every day, AND has not missed taking a pill at the correct day and time in the last month 85% 83% 96% 3/8* *Percentages are not used for pill users due to the small sample size.
  18. 18. MOST FBO CLIENTS USING SHORT-TERM METHODS CONTINUE USE AT 6 MONTHS. 85% 94% 82% 82% 3% 18% 12% 6% 18% SDM (n=158) TwoDay (n=47) Injectable (n=34) Pill (n=11) Discontinued use of method (not using any method) Transitioned to a new method Still using method at 6 months
  19. 19. MALE PARTNERS ARE INVOLVED IN METHOD USE, MOST OFTEN WITH FAM. SDM N=149 TWODAY N=48 INJECTION N=30 PILL N=8 94% 88% 57% 6/8* • Reminds me to move ring • Abstains on fertile days • Uses condoms on fertile days • Abstains on fertile days • Reminds me to check for secretions • Asks me if we can have sex • Reminds me when it is time for another injection • Gives me money to purchase injection, for transport to health facility, and for soft drinks during the journey • Reminds me to take pill • Gets refill for me • Buys soft drinks to use while taking the pills *Percentages are not used for pill users due to the small sample size.
  20. 20. 9.27 9.77 8.91 6.44 9.72 10.87 7.73 7.00 Standard Days Method (N=152) TwoDay Method (N=47) Contraceptive pill (N=11) Injectables (N=32) Relationship quality score at method initiation Relationship quality score at three months * ** IMPROVEMENT IN RELATIONSHIP SCORES FOR FAM USERS WAS STATISTICALLY SIGNIFICANT AFTER 3 MONTHS. *p<0.05 **p<0.01
  21. 21. CONCLUSION • Clients had positive perceptions of the counseling session • Improvements are needed re informed choice counselling across sites (Catholic sites need further strengthening in some cases) • Correct use and continuation of user- directed methods was high • Men were engaged in FP communication, decision making, and use - most often when using FAM FBOs can provide quality FP counselling leading to client satisfaction, correct use, continuation, and male involvement.
  22. 22. Conducting research with FBOs
  23. 23. Tips • Introduce the study to key stakeholders • Include local partners in study design, analysis, and publication • Balance confidentiality with information-sharing in the field • Tailor methods and instruments to faith context
  24. 24. A research agenda for faith and family planning What do you think?

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