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Melanie Lopez, MPH 21 June 2016

www.worldvision.org/our-impact/health

The Garba Tulla Healthy Timing & Spacing of Pregnancy Project: Increasing Contraceptive

Uptake in Northern Kenya

Healthy Mothers, Healthy Children: The Role of Faith Communities

Washington DC

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Background/Context: Garba Tulla, Kenya

Garba Tulla is a USAID-funded program, integrated into a larger Maternal and Child Health project (funded by WV Canada). Goal: To increase access to and use of voluntary Family Planning (FP) services through integration of Healthy Timing & Spacing of Pregnancies (HTSP) into a Maternal and Child Health (MCH) project in Garba Tulla District, Kenya • SO1: Increase access to FP services in the community • SO2: Increased knowledge & interest in HTSP/FP • SO3: Improved social & policy environment for FP services

and positive Reproductive Health behaviors

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Healthy Timing & Spacing of Pregnancies (HTSP). What does it mean?

• An intervention that focuses on healthy fertility to help women, men and families, time and space their pregnancies to achieve desired family size and the healthiest outcomes for newborns, children, and women.

• HTSP works within the context of free, informed and voluntary contraceptive choices.

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Where in the world is Garba Tulla, Kenya?

KENYA ISIOLO GARBA TULLA

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Points of integration to increase utilization for HTSP/FP

• Antenatal care: 73% of women get tetanus toxoid coverage during the fourth antenatal care visit

• Immunization: High immunization coverage (72.6 percent) for fully immunized children under 2

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Points of integration to increase utilization for HTSP/FP

• Faith Leaders: Sheiks and Imams

• Male Leaders: Chiefs, teachers, husbands, elders

• Community Health Volunteers (CHVs) and Community Health Extension Workers (CHEWs)

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SO: Community Mobilization –

Faith Leaders, Male involvement

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Results

0

100

200

300

400

500

600

Capacity Building, Male-FPcounseling/services for CHWs

Capacity Building, Male-FPcounseling/services for other providers

working in health facilities

Cacacity Building, Female-FPcounseling/services for CHWs

Capacity Building, Female-FPcounseling/services for other providers

working in health facilities

Number of community health workers (CHWs) and/or other health providers trained or supported, disaggregated by gender

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Results

0

200

400

600

800

1000

1200

1400

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15

Number of community members reached with family planning messages by type of provider

By CHEW (Other service providers in health facilities) By CHVs (Community health workers (CHWs)

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Successes

0

50

100

150

200

250

300

350

400

450

500

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15

# of clients receiving FP services integrated into MNCH services at the same location and time, disaggregated by sex

Male Female

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Successes

2870

0

1867

184

3

0

45

1098

1

605

0

514

724

0 500 1000 1500 2000 2500 3000

Male condom, Male

Male Sterilization, Male

SDM, Male

Emergency Contraception, Female

Female condom, Female

Female Sterilization

Implants, Female

Injectables, Female

IUD, Female

Female Lactational Amenorrhea

Male condom, Female

Oral Contraceptive Pills, Female

Standard Days Method (SDM), Female

# of current users, disaggregated by sex and method

# of current users by gender and method

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Successes

18 89

376

179

451

757

0

200

400

600

800

1000

1200

Sep-14 Dec-14 Mar-16 Jun-16 Sep-16 Dec,2015

Male condom, Male Male Sterilization, Male SDM, Male

Emergency Contraception, Female Female condom, Female Female Sterilization

Implants, Female Injectables, Female IUD, Female

Female Lactational Amenorrhea Oral Contraceptive Pills, Female Standard Days Method (SDM), Female

# of current users over time, disaggregated by sex and method

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Lessons Learned • The pivotal importance of men in FP programs

In traditional societies, where men are the gate-keepers who control all access to resources, the initial focus of FP programs must be on men – chiefs, elders, imams and fathers

• Increasing Contraceptive Use in conservative rural societies takes time In cultures with no tradition of contraceptive use, the initial step succeeds when it focuses on culturally compatible hormonal methods.

• Socio-cultural factors like early child marriage must be taken into consideration

Need to work on issues underlying child marriage through social norm-change interventions as well as economic interventions

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Acknowledgements Project Staff: • Cynthia Nyakwama – WV Kenya • Shano Guyo – WV Kenya • Adrienne Allison – WVUS

We thank: • USAID • Advancing Partners & Communities • Ministry of Health – Gov’t of Kenya