Uganda has one of the highest fertility rates and population growth rates in the world—putting the health of mothers and children at serious risk. It’s estimated that the simple act of birth spacing and access to family planning methods can reduce maternal mortality by 30 percent and child mortality by 20 percent. With less than 40 percent of women at reproductive age using modern contraceptives in Uganda, there’s tremendous opportunity for our Community Health Workers (CHWs) to provide family planning education and services to their communities.
To help fulfill this critical need, Living Goods has designed and launched a family planning pilot to expand family planning education and access to modern contraceptive methods through our network of CHWs. The pilot is part of a series of exciting initiatives we’re testing to deepen the impact and reach of our CHWs with support from the Innovation Investment Alliance. It will provide us with valuable learnings that will inform the roll out of comprehensive family planning services across the organization.
With less than 40 percent of women at reproductive age using modern contraceptives in Uganda, there’s tremendous opportunity for our Community Health Workers to provide family planning education and services to their communities.
It will help us answer questions like: Will community members have confidence in CHWs delivering these new services? Will they trust CHWs’ counsel on the benefits of different options and details on side effects? Will clients be willing to receive family planning services from someone within their community, or would they prefer this delivery in a more private setting?
While CHWs currently offer pills and condoms, the new pilot equips CHWs with the skills and education they need to fully inform community members on all available modern methods. Instead of just selling contraceptives, CHWs will be able to counsel families and help them make informed choices about family planning options. Excitingly, we received approval from the Ugandan Ministry of Health to distribute Sayana Press—a new method of injectable contraception. Other methods include the emergency contraceptive pill and the progesterone-only pill, which is suitable for breastfeeding mothers. To fully understand the impact of these services, we are piloting the experiment with 60 CHWs between two branches, the rural Mpigi branch and peri-urban Bwaise branch.
To date CHWs that are participating in the pilot have administered over 400 doses of contraceptives and made over 30 referrals for longer-term options. As Living Goods’ Innovation Manager in Uganda, I’ve had the opportunity to shadow CHWs throughout the process and observe reactions from the community first hand. I’m struck by the consistently positive responses we’ve received from a diverse range of clients.
At one home, a 21-year-old woman with a nine-month-old baby told us she was using the rhythm method, and had never used modern methods before. She explained that she was wary of modern family planning. She had seen her mother try many different methods—always resulting in bad side effects. Although cautious, she was curious, asking many questions throughout the education session. Despite her hesitation, the client chose to pay for Sayana Press in advance, and asked that her CHW come over the next day to administer it.
I’m struck by the consistently positive responses we’ve received from a diverse range of clients.
At the next household, a 32-year-old mother of seven—who had never used family planning—told us that she was not interested because she wanted ten children. She listened, however, and after hearing the CHW’s explanation of the methods and benefits, she asked her to come back in a couple of days while she thought about it.
Another women, a local shopkeeper, overheard us talking to her neighbor and approached to learn more. She had been using another injectable but was interested in a longer-term method, the implant. The CHW wrote the client a referral note to receive the implant at the local health facility when her three-month injectable runs out.
The overwhelmingly positive community response has been an encouraging indication that family planning services are much needed in the communities we serve. Following the initial training and community pilot, we have begun follow up trainings for each group of CHWs to continue to strengthen their family planning knowledge, solicit their feedback, and hear their challenges. We have also engaged a team at the Makerere School of Public Health to carry out some research throughout the pilot. The team will first conduct formative background research on current family planning use, behaviors and attitudes. Later in the pilot, they will conduct qualitative research with CHWs and clients, which will help paint a broader picture of our impact beyond the numbers we are gathering daily. This research, the data we collect through our mobile platform, and the critical feedback and experiences from CHWs, will shape the direction of the pilot moving forward and the decision to expand family planning offerings to all Living Goods branches.
In a recent training session, a CHW—who is herself a mother of seven—explained how her husband reacted when she told him about her family planning work. “I wish we had known about this when we had a chance!” he told her endearingly. “Let’s make sure to educate our children so that they do not have so many of their own children.”