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Issue 25 | DECEMBER 2010
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Promising SBCC interventions

C-Channel 25 highlights social and behavior change communication (SBCC) interventions in family planning/reproductive health (FP/RH) that may produce measurable results.

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Do BC interventions work?
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The first article concerns a study in India that suggests that SBCC strategies should be part of the training curricula of healthcare providers. The second found that a mass media promotion in Nepal motivated married men and their partners to discuss and use contraception. The third looked at SBCC messages that resonated for couples around adoption of modern FP methods. The last four articles reviewed reproductive health issues among young people and SBCC strategies that address them: interventions that generate demand and community support; a program that aimed to delay child marriage in Ethiopia; strategies used in Uganda to promote the adoption and sustained use of contraceptives; and the value of parental involvement in FP campaigns in four West African countries.

C-Change has launched the Gender Scales Compendium, a tool that practitioners may use to assess gender-related attitudes and beliefs in programs, and to evaluate health interventions that incorporate gender approaches.

 

In this Issue

Contraception, Family Planning, and SBCC

1. Knowledge, attitudes, and dispensing practices related to emergency contraceptives in India
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2. Impact of mass media promotion of FP among married males in Nepal
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3. Intentions to use contraceptives in Pakistan
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Youth and Reproductive Health

4. Generating youth demand and community support for SRH services
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5. Intervention to delay marriage in Ethiopia
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6. Factors that enable and inhibit use of contraceptives among young Ugandans
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7. Parental roles in contraceptive use in Burkina Faso, Ghana, Malawi, and Uganda
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Contraception, Family Planning, and SBCC

1. Providers' knowledge, attitude and dispensing practices of e-pills in government dispensaries of South district in Delhi, India

Authors: Kishore V; Misro MM; Nandan D
Institution: Department of Reproductive Biomedicine, National Institute of Health and Family Welfare, Baba Gangnath Marg, Munirka, New Delhi, India
Source: Indian Journal of Community Medicine, Jan 2010; 35(1): 46-51.

ABSTRACT
BACKGROUND: South Delhi is one of the well developed districts in the capital with best public health care facilities. Knowledge, attitude and dispensing practices of emergency contraceptive pills (E-pills) were assessed among health care providers of government dispensaries in South Delhi.
STUDY DESIGN: A descriptive epidemiological study.
MATERIALS AND METHODS: Both medical and paramedical (n = 428) providers in 63 government health care facilities were interviewed between August to December 2007 using a semi-structured interview schedule.
RESULTS: Among the different categories of the providers, medical officers were observed to be most knowledgeable about E-pills and the pharmacists were the least. The correct prescribed dose of E-pill was known only to 32% of the providers while 49% knew about its right time of intake. Misconceptions and apprehensions for promoting its use were very much prevalent even among medical officers as majority felt that open access to E-pills would increase promiscuity. The dispensing practice of providers was found positively (P < 0.05) correlated with their knowledge. Training resulted in a significant (P < 0.05) improvement in knowledge, attitude and dispensing practice of the providers. Knowledge and training combined together contributed 35% to the dispensing practice (R(2) = 0.35).
CONCLUSION: Besides knowledge, behavior change communication strategies should form a part of the training curricula of health care providers that would help to improve the dispensing practice of E-pills.

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2. The impact of mass media in using contraceptives among married males- a study from Hatiya VDC of Makawanpur, Nepal

Authors: Srijana Pandey a; Supendra Karki b
Institutions: a Department of Community Medicine, KIST Medical College, Imadol, Lalitpur, Nepal; b Hetauda School of Management and Social Sciences, Hetauda, Nepal
Source: Asian Journal of Medical Sciences, May 2010; 1(1): 9-11.

ABSTRACT
OBJECTIVES: To analyze the association between exposure to mass media and use of contraceptive.
METHODS: In this cross sectional descriptive study, 387 married males of Hatiya VDC were randomly selected. This study uses semi-structured questionnaire to acquire information regarding background character of respondents and the exposure of family planning message to mass media.
RESULTS: Both print and electronic media were found major reproductive health information dissemination tools. Exposure was positively related to age, education level, income, partner approval and discussed family planning with partner. There was no significant difference in exposure based on number of living children.
CONCLUSION: Findings from this study are consistent with the interpretation that mass media promotion of the family planning message motivated sexual partners to discuss use of the contraceptives, and that discussion exerted a strong influence on their intention to use it. The programmatic implications of these findings are that multiple media channels should continue to be used to promote family planning and other reproductive health issues. Priority should be given to media channels that reach large numbers of the intended audience, but supporting channels (such as print and interpersonal communication) should also be included in the media mix.
KEY WORDS: Mass media; Contraceptives

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3. Intentions to use contraceptives in Pakistan: Implications for behavior change campaigns

Author: Agha S
Institution: Population Services International, Washington, DC
Source: BMC Public Health, 2 Aug 2010; 10:450.

ABSTRACT
BACKGROUND: Since 1990-91, traditional method use has increased at a faster rate in Pakistan than modern method use. The importance of hormonal methods or the IUD has diminished and that of traditional methods has increased in the method mix. There is a need to identify factors motivating and deterring the adoption of specific family planning methods among married men and women in Pakistan.
METHODS: In addition to social and demographic characteristics of respondents, a representative household survey collected information on psychological correlates of family planning behavior from 1,788 non-pregnant wives and 1,805 husbands with not-pregnant wives. Males and females were from separate households. Principal components analysis was conducted to identify the underlying constructs that were important for each gender. Multinomial logistic regression analysis was conducted to determine the correlates of male and female intentions to use contraceptive methods.
RESULTS: Amongst women, the perception that her in-laws support family planning use was the strongest determinant of her intentions to use contraceptive methods. A woman's belief in the importance of spacing children and her perception that a choice of methods and facilities with competent staff were available were also powerful drivers of her intentions to use contraceptive methods. The strongest obstacle to a woman's forming an intention to use contraceptive methods was her belief that family planning decisions were made by the husband and fertility was determined by God's will. Fears that family planning would harm a woman's womb lowered a woman's intentions to use methods requiring procedures, such as the IUD and female sterilization.The perception that a responsible, caring, husband uses family planning to improve the standard of living of his family and to protect his wife's health was the most important determinant of a man's intention to use condoms. A husband's lack of self-efficacy in being able to discuss family planning with his wife was the strongest driver of the intention to use withdrawal. A man's fear that contraceptives would make a woman sterile and harm her womb lowered his intention to use modern contraceptive methods.
CONCLUSIONS: These findings highlight the importance of having secondary target audiences such as mothers-in-law and husbands in family planning behavior change campaigns implemented in Pakistan. Campaigns that stress the importance of child spacing are likely to have an impact. Client perceptions of the quality of care are important determinants of intentions to use contraceptive methods in Pakistan. Client concerns that the IUD and sterilization procedures might harm a woman's womb and cause sterility should be addressed. The findings suggest that there is a need to assess the actual quality of service delivery in Pakistan.

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Youth and Reproductive Health

4. Generating demand and community support for sexual and reproductive health services for young people: A review of the literature and programs

Authors: Kesterton AJ 1; Cabral de Mello M 2
Institutions: 1 Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK; 2 World Health Organization, Geneva, Switzerland
Source: Reproductive Health, 24 Sep 2010; 7:25.

ABSTRACT
BACKGROUND: This review investigates the effectiveness of interventions aimed at generating demand for and use of sexual and reproductive health (SRH) services by young people; and interventions aimed at generating wider community support for their use.
METHODS: Reports and publications were found in the peer-reviewed and grey literature through academic search engines; web searches; the bibliographies of known conference proceedings and papers; and consultation with experts. The studies were reviewed against a set of inclusion criteria and those that met these were explored in more depth.
RESULTS: The evidence-base for interventions aimed at both generating demand and community support for SRH services for young people was found under-developed and many available studies do not provide strong evidence. However, the potential of several methods to increase youth uptake has been demonstrated, this includes the linking of school education programs with youth friendly services, life skills approaches and social marketing and franchising. There is also evidence that the involvement of key community gatekeepers such as parents and religious leaders is vital to generating wider community support. In general a combined multi-component approach seems most promising with several success stories to build on.
CONCLUSIONS: Many areas for further research have been highlighted and there is a great need for more rigorous evaluation of programmes in this area. In particular, further evaluation of individual components within a multi-component approach is needed to elucidate the most effective interventions.

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5. Evaluation of Berhane Hewan: A program to delay child marriage in rural Ethiopia

Authors: Erulkar AS 1; Muthengi E 2
Institutions: 1 Population Council, Addis Ababa, Ethiopia; 2 University of California, Los Angeles, School of Public Health, Los Angeles, CA
Source: International Perspectives on Sexual and Reproductive Health, Mar 2009; 35(1): 6-14.

ABSTRACT
CONTEXT: Early marriage limits girls' opportunities and compromises their health, yet in Sub-Saharan Africa many girls are married before the age of 18, and few programs have sought to increase the age at marriage on the continent.
METHODS: Berhane Hewan was a two-year pilot project conducted in 2004-2006 that aimed to reduce the prevalence of child marriage in rural Ethiopia, through a combination of group formation, support for girls to remain in school and community awareness. A quasi-experimental research design with baseline and endline surveys was used to measure changes in social and educational participation, marriage age, reproductive health knowledge and contraceptive use. Chi-square tests, proportional hazards models and logistic regressions were conducted to assess changes associated with the project.
RESULTS: The intervention was associated with considerable improvements in girls' school enrollment, age at marriage, reproductive health knowledge and contraceptive use. Particularly among girls aged 10-14, those exposed to the program were more likely than those in the control area to be in school at the endline survey (odds ratio, 3.0) and were less likely to have ever been married (0.1). However, among girls aged 15-19, those in the intervention area had an elevated likelihood of having gotten married by the endline (2.4). Sexually experienced girls exposed to the intervention had elevated odds at endline of having ever used contraceptives (2.9).
CONCLUSIONS: The success of the Berhane Hewan program, one of the first rigorously evaluated interventions to delay marriage in Sub-Saharan Africa, suggests that well-designed and effectively implemented programs can delay the earliest marriages until later adolescence.

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6. Persistent high fertility in Uganda: Young people recount obstacles and enabling factors to use of contraceptives

Authors: Nalwadda G 1,2,3; Mirembe F 2; Byamugisha J 2; Faxelid E 3
Institutions: 1 Department of Nursing, College of Health Sciences Makerere University, Kampala, Uganda; 2 Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, Kampala Uganda; 3 Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Source: BMC Public Health, 3 Sep 2010; 10:530.

ABSTRACT
BACKGROUND: High fertility among young people aged 15-24 years is a public health concern in Uganda. Unwanted pregnancy, unsafe induced abortions and associated high morbidity and mortality among young women may be attributed to low contraceptive use. This study aims at exploring reasons for low contraceptive use among young people.
METHODS: In 16 focus group discussions, the views of young people about obstacles and enabling factors to contraceptive use in Mityana and Mubende districts, Uganda were explored. The groups were homogeneously composed by married and unmarried men and women, between the ages of 15-24. The data obtained was analyzed using qualitative content analysis.
RESULTS: Young men and women described multiple obstacles to contraceptive use. The obstacles were categorized as misconceptions and fears related to contraception, gender power relations, socio-cultural expectations and contradictions, short term planning, and health service barriers. Additionally, young people recounted several enabling factors that included female strategies to overcome obstacles, changing perceptions to contraceptive use, and changing attitude towards a small family size.
CONCLUSIONS: Our findings suggest changing perceptions and behavior shift towards contraceptive use and a small family size although obstacles still exist. Personalized strategies to young women and men are needed to motivate and assist young people plan their future families, adopt and sustain use of contraceptives. Reducing obstacles and reinforcing enabling factors through education, culturally sensitive behavior change strategies have the potential to enhance contraceptives use. Alternative models of contraceptive service delivery to young people are proposed.

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7. Role of parents in adolescent sexual activity and contraceptive use in four African countries

Authors: Biddlecom A 1; Awusabo-Asare K 1; Bankole A 3
Institutions: 1 Guttmacher Institute, New York, NY; 3 Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
Source: International Perspectives on Sexual and Reproductive Health, Jun 2009; 35(2): 72-81.

ABSTRACT
CONTEXT: Parents have an influence on the sexual and reproductive health of adolescents, but evidence from Sub- Saharan Africa is limited. A better understanding of the relationship between different dimensions of parenting and recent sexual activity and contraceptive use is needed in the region.
METHODS: Data were collected in 2004 in nationally representative surveys of 12-19-year-olds in Burkina Faso, Ghana, Malawi and Uganda. Bivariate analysis compared gender differences for two outcomes among unmarried 15-19-year-olds-having had sexual intercourse in the last 12 months and, among those who had had sex in this period, contraceptive use at last sex. Multivariate logistic regression analysis identified associations between these outcomes and coresidence with parents or parent figures, parental monitoring and parent-child communication.
RESULTS: Unmarried adolescents reported moderate to high levels of parental monitoring and low levels of parent-child communication about sexual matters. In all countries, adolescent males who reported low monitoring were at elevated risk of having had sex in the last year (odds ratios, 2.4-5.4), as were their female counterparts in three of the countries (6.9-7.7). Communication with parents was positively associated with sexual activity among Malawian males and Ugandan females (2.2 and 1.5, respectively). Parental monitoring was not associated with contraceptive use at last sex, whereas parent-child communication was associated with such use among Ghanaian females (3.0) and among Ugandan adolescents of both genders (1.9-2.0).
CONCLUSIONS: Programs to improve adolescent sexual and reproductive health should include dimensions of parental involvement that can strengthen the program's specific behavior change goals.

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