This document evaluates the impact of a maternal and neonatal health community mobilization and behavior change intervention in Guatemala.

This paper examines the role of community groups in Kenya in promoting the diffusion of family planning knowledge, attitudes and practice.

 

Context: Training alone may not be sufficient to prompt complex and lasting changes in the performanceof family planning providers. Affordable and effective reinforcement mechanisms areneeded to ensure that providers apply new skills on the job. Methods: In December 1997 and January 1998, 201 providers working at 170 clinics in Indonesiaattended a training course on client-centered counseling. They were divided into three subgroupsfor follow-up. One group (controls) received no reinforcement, one conducted weekly selfassessmentsand the third attended peer-review meetings in addition to conducting selfassessments. Data were collected before training, immediately afterward and after four monthsof reinforcement to measure changes in provider and client behavior. Results: In the month after training, counseling sessions were about twice as long as before,and providers offered twice as much information and counseling on medical and family planningissues. The frequency of providers’ facilitative communication (which fosters rapport and clientparticipation) doubled from 15 to 30 instances per session, and the number of clients’ questionsincreased from ١٫٦ to ٣٫٣. After reinforcement, providers’ facilitative communication, clients’ activecommunication and clients’ ratings of self-expression and satisfaction increased in the selfassessmentgroup, but did not change significantly in the control group. Both providers’ facilitativecommunication and clients’ active communication improved further in the peer-review group,but this intervention did not affect clients’ perspectives on the counseling experience. Conclusions: Self-assessment and peer review help maintain providers’ performance aftertraining and prompt continuous quality improvement.

 

This paper explores the knowledge, attitudes and beliefs about family planning among Muslim religious leaders in Jordan and how their perceptions differ from the general public.

 

Context: Muslim religious leaders are often viewed as real or potential obstacles to family planning. Research is needed to understand more fully their knowledge, attitudes and beliefs about family planning and how they differ from those held by the general public. Methods: Two nationally representative surveys, one of ١٬٠٠٠ married women aged 15–49 and the other of ١٬٠٠٠ men married to women aged 15–49, and a census of all Muslim religious leadersin Jordan collected information on knowledge, attitudes and beliefs regarding family planning, and sources of information about it. Results: Eighty percent of men, 86% of women, 82% of male religious leaders and 98% of femalereligious leaders believe that family planning is in keeping with the tenets of Islam. Among religious leaders, 36% reported that they had preached about family planning in the year preceding the survey. Seventy-five percent of women and 62% of men in the general public saidthat they had spoken about family planning with their spouse, and 9% and 17%, respectively, reported having spoken with a religious leader. On a scale of 0–10 measuring agreement with statements regarding the benefits of family planning (with 10 being complete agreement), womenaveraged ٩٫٤ and men ٨٫٨, while male religious leaders averaged ٦٫٥ and female religious leaders ٧٫٢. Among the general public, 74% of women and 58% of men said that deciding to practicecontraception is a joint decision between husband and wife. About 90% of religious leaders agreed or agreed strongly with the statement that contraceptive decisions should be made jointly by husband and wife. Women were significantly more likely than men to believe that specific contraceptive methods are permitted under Islam, and male religious leaders were more likely than were men in the general population to find specific methods acceptable. Only 26% of men cited interpersonal communication as a source of family planning information, compared with 66% of women, 73% of male religious leaders and 89% of female religious leaders. Almost three quarters of men and women said they want to know more about family planning. Conclusion: Although Islamic religious leaders in Jordon cite different reasons than the generalpublic to justify the use of contraceptives, they are as likely as others in the population toapprove of family planning.

 

Guatemalan women, their families, and their neighbors exposed to an innovative safe motherhood program now know what to do in case something goes wrong during pregnancy, childbirth, or postpartum. Recognizing obstetrical emergencies and taking appropriate action are the goals of the Guatemalan Ministry of Health and Public Assistance (MOH) and the Maternal and Neonatal Health Program (MNH) implemented by JHPIEGO, an affiliate of Johns Hopkins University, and John Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP). The U.S. Agency for International Development supports the MNH Program through its Guatemala-Central American Program. Taking action in a timely manner helps save women’s lives and reduce maternal mortality.

This paper presents an assessment of a project aimed to encourage young people to adopt behaviors that reduce the risk of pregnancy and STIs, including HIV. The paper outlines the project's success at reaching its target audience and promoting responsible sexual behavior among young people.

 

Context: A 1997–1998 multimedia campaign promoted sexual responsibility among young peoplein Zimbabwe, while strengthening their access to reproductive health services by training providers. Methods: Baseline and fo l l ow-up survey s, each involving approximately ١٬٤٠٠ women and menaged 10–24, were conducted in five campaign and two comparison sites. Logistic regression analyses were conducted to assess exposure to the campaign and its impact on young people’s reproductive health knowledge and discussion, safer sexual behaviors and use of services. Results: The campaign reached 97% of the youth audience. Awareness of contraceptive methodsincreased in campaign areas, but general reproductive health knowledge changed little. As a result of the campaign, 80% of respondents had discussions about reproductive health—withf riends (72%), siblings (49%), parents (44%), teachers (34%) or partners (28%). In response tothe campaign, young people in campaign areas were ٢٫٥ times as likely as those in comparisonsites to report saying no to sex, ٤٫٧ times as likely to visit a health center and ١٤٫٠ times aslikely to visit a youth center. Contraceptive use at last sex rose significantly in campaign areas (from 56% to 67%). Launch events, leaflets and dramas were the most influential campaign components. The more components respondents were exposed to, the more likely they were to take action in response. Conclusions: A multimedia approach increases the reach and impact of reproductive health inte rventions directed to young people. Building community support for behavior change also is essential, to ensure that young people find approval for their actions and have access to services. 

 

This paper explores the relationship between quality improvements in family planning delivery sites and increased contraceptive use among target populations.

 

 

Context: Sub-Saharan Africa has a considerable unmet need for contraception. In 1998–1999,the Gold Circle campaign—a regional initiative to promote and improve family planning servicedelivery sites—was launched in Cameroon. Methods: During the last quarter of 1999, 571 women who had been interviewed during the1998 Cameroon Demographic and Health Survey were reinterviewed regarding their exposureto the Gold Circle campaign and their perceptions on and use of contraceptives. The impact ofthe campaign was evaluated by assessing the panel data and by using an ideation model of behaviorchange. In addition, service statistics from Gold Circle and non-Gold Circle family planningdelivery sites were contrasted to assess the effects of the campaign on clinic performance. Results: More than one-third of the women surveyed reported exposure to the Gold Circle campaign,52% of whom mentioned being exposed to the campaign through television. Those withprimary or postprimary education were four and six times as likely, respectively, as those withno education to have been exposed to the campaign. Exposure was associated with a significantincrease in the level of family planning ideation, as well as with an increased likelihood ofusing a modern contraceptive method (80%). The service statistics indicate that the campaignled to a significant increase in the demand for family planning services at Gold Circle clinics,with the number of new clients more than doubling immediately after the campaign launch. Conclusions: The Gold Circle campaign had appreciable success in promoting family planningin Cameroon. The campaign had a considerable positive influence on both family planning ideationand contraceptive use.

 

 

Context: Training alone may not be sufficient to prompt complex and lasting changes in the performanceof family planning providers. Affordable and effective reinforcement mechanisms areneeded to ensure that providers apply new skills on the job. Methods: In December 1997 and January 1998, 201 providers working at 170 clinics in Indonesiaattended a training course on client-centered counseling. They were divided into three subgroupsfor follow-up. One group (controls) received no reinforcement, one conducted weekly selfassessmentsand the third attended peer-review meetings in addition to conducting selfassessments.Data were collected before training, immediately afterward and after four monthsof reinforcement to measure changes in provider and client behavior. Results: In the month after training, counseling sessions were about twice as long as before,and providers offered twice as much information and counseling on medical and family planningissues. The frequency of providers’ facilitative communication (which fosters rapport and clientparticipation) doubled from 15 to 30 instances per session, and the number of clients’ questionsincreased from ١٫٦ to ٣٫٣. After reinforcement, providers’ facilitative communication, clients’ activecommunication and clients’ ratings of self-expression and satisfaction increased in the selfassessmentgroup, but did not change significantly in the control group. Both providers’ facilitativecommunication and clients’ active communication improved further in the peer-review group,but this intervention did not affect clients’ perspectives on the counseling experience. Conclusions: Self-assessment and peer review help maintain providers’ performance aftertraining and prompt continuous quality improvement.

 

Family planning communications campaigns have been shown to increase contraceptive use, but it remains unclear whether exposure to messages about contraception through multiple media sources has a greater impact than exposure through one medium. This paper examines the impact of multimedia family planning promotion on the contraceptive behavior of women in Tanzania.