First-Time Parents: Time of Transition - Regina Benevides

1. 1
First-Time Parents: time of transition
Regina Benevides
Pathfinder International/ Evidence to Action Project
CORE GROUP Fall Conference

2. 2
Who are FTP?
Young women under
the age of 25 who are
pregnant or already
have one child, and
their partners

3. 3
Focus on FTP: a right, a need, an opportunity
• Delay first birth
• Space second birth
• Improve maternal health
outcomes
• Improve infant health
outcomes
• Foster equitable gender norms
• Support gender equitable
childrearing

4. 4
• Builds on Lifecycle Approach
• Brings attention to the ‘universal’, but always particular
experience of having a first child
• Platform to address multiple priorities:
Youth
Gender
Expanded Method Choice (HTSP, PPFP)
FP Integration
Focus on FTPs

5. 5
What we know that works
DEMAND-SIDE
• Young married women’s knowledge
and desires
• Desires of their partners and
families, peer and community
norms
• Power dynamics in their marriage
and households
• Broader gender environment in
which they live
SUPPLY-SIDE
• Provider bias/Power dynamics
between clients and providers
• Distance to a health facility
• Community- and facility-based
health services don’t offer full
range of contraceptives
• Prohibitive rules and regulations
Factors that influence closely-spaced pregnancies
Enabling
enviroment

6. 6
E2A Literature Review Recommendations
Build young women’s human and social capital
Cultivate the support of husbands, parents and in-laws
Create an enabling environment for the reproductive planning of FTPs
Ensure the services exist and can be accessed
Improve quality of care for young mothers
Establish supportive laws, policies and systems

7. 7
The ‘What’
• HTSP and SRH
• ANC/PNC
• Safe delivery
• PMTCT
• Breastfeeding
• Nutrition
• Immunization
• SBCC

8. 8
The ‘How’

9. 9
Moving from Concept to Reality
Who are these FTPs?
Who is in their circle of influencers?
What services do they need and
how can we make them available,
accessible, affordable?
What health outcomes should be prioritized?
What social determinants interfere
in their behavior outcomes?
Who and what should we engage to
meet FTP needs?
What can we learn from our FTP
program?
What partners do we have on the
ground?

10. 10
Complex-Context Specific Interventions
Context Who What
Key
Influencers
How
Burkina Faso:
Rural and peri-urban;
Polygamous; Muslim;
Out-of-school
Public and NGO
supported facilities
Young
married
mothers
HTSP(FP/PPFP)
(commodities paid)
Mothers-in-law
Co-wives
Male FP
supporters
CHW: House visits;
Community meetings
YM groups
HP FP/FTP trained
Tanzania:
Rural; Catholic; Out-of-
school;
Public sector
Young
unmarried
mothers
HTSP (FP/LARCs/
Integration with
Immunization)
(free commodities)
Knowledge, agency
on FP
Mothers
Male FP
supporters
CHW House visits
YM groups
HP trained in
FP/LARCs/FTP
Outreach
immunization days
Nigeria:
Peri-urban; Christian;
Out-of-school; Private
sector
Young
unmarried
HIV+
mothers
Male
partners
PMTCT
(commodities paid)
Male FP supporters
Couple: gender
equitable
childbearing
Mothers-in-law CHW House visits
Husbands & couple
counseling
YM groups
HP trained FP/FTP

11. 11
Key Findings Burkina Faso
HOW TO ENGAGE MOTHERS-IN-LAW
• Involve mothers-in-law
at the beginning
• Adapt to different
attitudes in peri-urban
vs. rural
• Enlist older animateurs
(peri-urban) and
religious leaders (rural)

12. 12
Key Findings: Burkina Faso
HOW TO ENGAGE HUSBANDS
• Encounters at
home, places of
work & leisure
• Different strategies
for young husbands
vs. older husbands
• Enlisting supportive
mothers-in-law and
religious leaders

13. 13
Key Findings: Burkina Faso
HOW TO ENGAGE CO-WIVES
• Understand the concept of
“co-wife” in specific contexts
• Recognize different types of
influence among co-wives
• Speak separately with co-
wives
• Enlist supportive mothers-in-
law
• Invite co-wives to participate
in small peer groups

14. 14
Improvements
• Need for additional
supporting peer leaders
in SRH/FP
• Strategic approach for
male engagement
• Systematically address
bias in providing LARCs
to young unmarried
and married mothers
Areas for Improvement and Strengths
Strengths
• Role of Peers through
small groups increasing
access to services
• Integrated Supervision
system: HP-CHW-Peers
• Multisectoral approach
• Involvement of key
influencers

15. 15
Info@E2AProject.org
Www.E2AProject.org
@E2AProject
Facebook.com/E2A Project
Thank you!

16. 16
Provider Bias