evaluations of msi’s mobile outreach services in india and zimbabwe ian askew population council

Evaluations ofMSI’s Mobile Outreach Services in India and Zimbabwe

Ian Askew

Population Council

2

Why Mobile Outreach? In principle it….

Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International

Increases access to clinical methods for populations living far from qualified personnel and facilities

Enhances acceptability for family planning generally, and clinical methods specifically

Improves choice of methods available to better meet individual needs

Offers safe, quality services through various assurance mechanisms and routine client follow-up

Reduces costs of travel, time from work and commodity price (through subsidization)

3

Evaluation Methods


Where?- 235 sites, 4 districts of Rajasthan State, India- 26 sites, 4 provinces of ZimbabweWho and when?- India:

• 875 TL clients; 402 IUD clients• Pre-procedure and exit interviews; 15-day interviews• 90 day interviews with IUD clients

- Zimbabwe:• 610 Implant clients; 48 IUD clients; 7 TL clients• Client-provider observations; exit interviews; 15-day

interviews

4 Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International

Findings

5

Who accesses these services?

Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe

India• Married, rural women, mostly

housewives

• Two-thirds TL clients in late 20s; Wider age range for IUD clients

• 60% TL clients have 3+ children; 60% IUD clients have 1-2 children

• 30-50% no schooling; 31-53% secondary+ education

• 80-82% low caste families

• 44% (TL) and 61% (IUD) high standard of living

• Most women never used modern method previously

Marie Stopes International

Zimbabwe• One-quarter unmarried, ¾ rural

women

• Wide age range, including 12% under 20 years

• Average parity 3; 25% have 4+ children

• 60% secondary+ education

• One half are housewives

• 13% living on $2.50 or less per day

• All women had previously used a method (pills); 62% unintended pregnancy while using

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Who accesses these services?


India• Day of procedure:

• Any side effect (mostly pain):– TL 35%– IUD 23%

• Moderate-severe pain:– TL 3.4%– IUD 1.2%

• 15 days post procedure:• Any side effect (mostly pain):

– TL 15%– IUD 21%

• Moderate-severe pain:– TL 3.9%– IUD 5.0%


Zimbabwe• Day of procedure:

• Pain:– Implant: 32% (17%

moderate)– IUD: 35%– TL: All (1/7 moderate)

• Bleeding:– All cases very mild or

mild, except 1 IUD (severe)

• 15 days post procedure:• Moderate pain:

– Implant: 1%– IUD: 10%– TL: 1/7

• Bleeding:– 1/48 IUD moderate– 1/7 TL severe

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IUD discontinuation at 90 days (in India)


Among the 32 discontinuing, 15 switched to:

TL (5), pill (7) and condom (3)

Among the 361 continuing,46% reported side effects

Excessive menstrual pain

Prolonged menstrual bleeding

Low backache

Lower abdominal pain

Indigestion / discomfort in abdomen

Irregular menstrual cycle

Excessive menstrual bleeding

Experienced no side effects

0 20 40 60 80 100

5

6

10

12

12

17

19

54

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What quality do they receive (in Zimbabwe)?


GBV discussed

HIV testing offered

Dual protection counseling

Breastfeeding

Breast cancer history

Pregnancy symptoms

Timing of next birth

Desired no. of children

Friendly & respectful*

Provider listened*

0 10 20 30 40 50 60 70 80 90 100

12

61

100

78

74

25

49

51

97

95

* = client exit interview

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Conclusions


A. Mobile outreach services can effectively reach underserved populations to expand range of services

B. Meeting the needs of women with a range of socio-demographic characteristics

C. Acceptable levels of adverse events experiencedD. In India, IUD discontinuation rate of 8% at 90 days is

relatively high, and only half of women switched method

E. In Zimbabwe, quality of care is generally good, with most women receiving an integrated service

Your questions…



evaluations of msi’s mobile outreach services in india and zimbabwe ian askew population council

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