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Filling the Void: Increasing the Use of Family Planning Services in Timor-Leste

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This poster was presented by Elia Fernandes and Antonia Mesquita at the International Conference on Family Planning (ICFP) in Kigali, Rwanda in November 2018.

USAID’s Reinforce Basic Health Services Project, implemented by JSI Research & Training Institute, Inc. (JSI) addresses declining availability and use of modern family planning (FP) services. When the program began in 2016, a significant proportion of women were not well-informed about side effects or method options available to them. Myths and misconceptions about the benefits of FP, gender roles, religion, and cultural and other belief systems all affect demand for FP. Using a comprehensive social and behavior change approach at both the individual and facility level, community and system interventions were held. They developed five short films and held community discussion groups to improve knowledge of FP methods and their benefits. They also worked with communities to develop action plans to improve community access to FP services.

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Filling the Void: Increasing the Use of Family Planning Services in Timor-Leste

  1. 1. Timor-Leste FILLING THE VOID: INCREASING THE USE OF FAMILY PLANNING SERVICES IN TIMOR-LESTE AUTHORS: Elia Fernandes, Antonia Mesquita, Elizabeth Bunde, and Marianne Viatour—JSI Research & Training Institute, Inc. BACKGROUND USAID’s Reinforce Basic Health Services Project, implemented by JSI Re- search & Training Institute, Inc. (JSI) addresses declining availability and use of modern family planning (FP) services. When the program began in 2016, a significant proportion of women were not well-informed about side effects or method options available to them. CONCLUSIONS To develop interventions and messaging to increase demand for and use of FP methods: • Identify messages that resonate with clients to showcase benefits and minimize misconceptions. • Increase exposure to FP information in community, rather than only facility settings. • Foster a “men-as-partners” culture for family planning to address gender roles. • Learn from the client perspective and experiences to make sure they receive the information they need. Community Interventions 1. Held community discussion groups for all men and women of reproductive age in Covalima’s 147 communities (aldeias) to improve knowledge of FP methods and their benefits. 2. Developed five two-minute films and printed materials to share key FP messages. System Interventions: 1. 72% of all the communities in the district have participated in FP-focused community discussion groups. 2. Four villages have developed action plans to improve community access to FP services, especially around innovative transport options for couples seeking FP services. RESULTS • In the 27 months since interventions were implemented, more than 350 FP-focused discussion groups were held, attended by more than 4,000 women and more than 1,000 men. • Of the 25 public health facilities in the district, all are staffed with health providers certified to provide FP counseling and short-acting methods. Among these, 17 are staffed with at least one health provid- er certified to provide long-acting reversible contraceptive methods. • There have also been marked improvements in FP use with an almost two-fold increase in couple years of protection (CYPs). The proportion of CYPs attributed to injectables has increased three-fold, with pill CYPs increasing more than five-fold, and CYPs attributable to implants increasing by 60%. PROGRAM INTERVENTION Using a socio-ecological perspective, JSI developed a comprehensive social and behavior change (SBC) approach: • Individual level behavior change: community discussion groups and face-to-face interpersonal outreach approaches with targeting messaging • Facility level behavior change: health workers’ skills in FP methods and counseling were improved to increase access to FP methods and client/provider interactions supported by SBC communication materials for client and provider needs. Demand for Family PlanningMyths and misconceptions about the benefits of FP, gender roles, religion, and cultural and other belief systems all affect demand for FP. INDIVIDUAL LEVEL BEHAVIOR CHANGE FACILITY LEVEL BEHAVIOR CHANGE COMPREHENSIVE SOCIAL & BEHAVIOR CHANGE (SBC) APPROACH community discussion groups and face-to-face interpersonal outreach approaches with targeting messaging health workers’ skills in FP methods and counseling were improved to increase access to FP MORE THAN 350FP-FOCUSED DISCUSSION GROUPS WERE HELD, ATTENDED BY... 72%OF ALL THE COMMUNITIES IN THE DISTRICT PARTICIPATED IN FP-FOCUSED DISCUSSION GROUPS. ...MORE THAN 4,000 WOMEN,AND MORE THAN 1,000 MEN OF THE 25 PUBLIC HEALTH FACILITIES IN THE DISTRICT ALLARE STAFFED WITH FP-CERTIFIED HEALTH PROVIDERS ...AT A GLANCE METHODOLOGY

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