New Messages Build Male Support and Boost Contraceptive Use in Senegal

April 2, 2014Adrienne Allison, MA, MPASenior Technical Advisor

FP/RH World Vision1

Objectives

To demonstrate the impact of:

• including outreach to boys and men in family planning (FP) programs in traditional societies

• building male support for FP by focusing on the health benefits of “Healthy Timing and Spacing of Pregnancies”

Background - Family Planning in Senegal

FP policies and programs introduced 50+ years ago were based on two rationales:• demographic - rapid population growth• economic – accelerating development.

They focused on increasing women’s access to FP services.

They largely ignored the structure of Senegal’s traditional society, where men control most decisions about desired family size and contraceptive use.

Results: Senegal’s contraceptive prevalence rate (CPR) is 11%, among the lowest in the world.

World Vision reached out to men with new FP messages focused on healthy fertility

World Vision recognized that men valued the health of children, mothers and communities.

Using Healthy Timing and Spacing of Pregnancies (HTSP) data, WV tailored HTSP messages for:• Civic officials, religious leaders,

community elders, fathers and boys• Ministry of Health (MOH) providers• Male village health workers

2.97

2.22

1.81

1.49

1.22 1.141.00 0.96 0.92

1.05

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

<6 6-11 12-17 18-23 24-29 30-35 36-47 ref. 48-59 60-95 96+

Adj.

Rel

ativ

e R

isk

Interval in months

Under Five Mortality by Birth to Conception Interval52 DHS Surveys

1,049,122 births

5

HTSP and under 5 Mortality

Rutstein, Measure DHS, 2008

Percent of Children Alive and Not Undernourished by Duration of Preceding Birth to Conception Interval

75%

71%

63%63%

59%

55%52%

48%

43%45%

40%

45%

50%

55%

60%

65%

70%

75%

80%

<6 6-11 12-17 18-23 24-29 30-35 36-47 ref. 48-59 60-95 96+

Interval in months

Perc

ent o

f chi

ldre

n

Alive and notundernourished

Shea Rutstein, Ph.D., Measure DHS 2008

352,447 births in 52 DHS surveys

6

Healthy Timing and Spacing of Pregnancy Messages

• Delay the first pregnancy until a girl is 18

• Wait until a child is at least 2 before trying to become

pregnant again

• Wait at least six months before trying to become pregnant again after a miscarriage or abortion

• Limit pregnancies to a mother’s healthiest years—ages 18 to 34

7

Mobilizing Male Support

World Vision provided information for:• Civic officials – data on spacing births

and saving lives• Religious leaders – discussions on the

Holy Koran’s support for timing and spacing pregnancies

• Community elders – messages for fathers and mothers

• Boys and men – banners and fliers at sporting events, community rallies and local competitions

All designed to build knowledge, increase understanding and provide a common language about HTSP and FP.

Campaign with Civic & Islamic Leaders

Challenges & Outcomes

• Lack of knowledge fed rumors about the side effects of using contraception

• Women perceived that men did not support FP and hid their contraceptive use

• Imams thought that FP programs were designed to limit births and control population growth

Outcomes - In 12 months the CPR rose from:• 2% to 9% at Health Huts• 12 % to 17 % at Health Posts

Outcomes, Lessons Learned, Results

Lessons Learned -• Men respond well to HTSP messages and help accelerate FP uptake• Educating men empowers them to make informed decisions to

support FP • FP programs benefit when they include men as partners• Demand generation and services must be simultaneous

Results -• The goal of the Ministry of Health (MOH), Department of

Reproductive Health is to build a healthy population• MOH calls for all births to be spaced in order to reduce infant

mortality.

Thank you!