E2A Newsletter, August 2015

Reaching young married women, first-time parents in Burkina Faso


Photo credit: Abdoul Baldé, Pathfinder International

E2A focuses its youth work on programs that are uniquely designed to reach and serve diverse young populations. One of those populations is first-time parents—young married mothers under the age of 25 and their partners, who have one child—a group that has largely been neglected by sexual and reproductive health programs to date.

Through an intensive qualitative monitoring and documentation process, E2A recently co-authored a technical brief that discusses key findings from a project led by Pathfinder International, which has supported increased contraceptive use among young married women, including first-time parents, for the healthy timing and spacing of pregnancies (HTSP). The technical brief discusses findings that can be applied to support these populations to access information and contraceptive services that would allow them to practice HTSP in similar contexts.

A longer technical report that examines process and findings more thoroughly will be available in late September.

Findings from the documentation include the following and demonstrate how they can be put into practice in the Burkinabe context and similar contexts:

  • Implementers must first cultivate the engagement and support of key gatekeepers—such as mothers-in-law, co-wives, and male partners—to influence the decision-making process of young married women and first-time parents.
  • Program approaches must be tailored differently to reach young married women and first-time parents in urban versus rural settings, including messages to key gatekeepers.
  • Strategies must be adapted to reach the different subsets of young married women: young married women with no children, first-time parents, and young married women with several children.

The findings will be discussed further on September 23, from 11:30 am-1 pm, during a webinar led by E2A and Pathfinder International entitled “Learning through Implementation: Reaching First Time Parents and Young Married Women in Burkina Faso.” During the webinar, participants will learn more about the importance of addressing the specific needs of first-time parents; the approach taken by E2A and Pathfinder International to ensure learning, documentation, and evidence generation were embedded in the project design; and the findings, which were mainly derived from the perspectives of local frontline implementers.  Speakers will include:

  • Moderator: Margot Fahnestock, Program Officer, Global Development and Population Program, The William and Flora Hewlett Foundation
  • Callie Simon, Senior Technical Advisor for Applied Learning in Sexual Reproductive Health & Rights, Pathfinder International
  • Abdoul Baldé, Program Manager, Pathfinder International West Africa Region
  • Katie Chau, Senior Youth Advisor, E2A

You can register for the webinar here.

Healing Hands of Joy: an essential organization for Ethiopia’s National Fistula Elimination Plan

According to Healing Hands of Joy—an organization which E2A supports in Ethiopia to rehabilitate and reintegrate women who have undergone obstetric fistula repair surgery—obstetric fistula is a double sorrow. A woman loses her baby as a result of a long, painful, obstructed labor and then wakes up to incontinence, among other physical ailments.  She is often abandoned by her husband, ostracized by her family and village, and left to live the rest of her life alone and ashamed.  Even when treated medically, some women continue to suffer a lack of self-esteem, self-confidence, and the effects of being ostracized.

By working closely with women who have undergone obstetric fistula repair surgery, Healing Hands of Joy supports these women to resume full and productive lives. Healing Hands of Joy specifically conducts the following activities:

  • Offers survivors psychological, social, and spiritual counseling and support with business development education to transform lives and communities.
  • Educates women who have been treated—transforming them into Safe Motherhood Ambassadors who can inform pregnant women in their communities about accessing safe-delivery services.

Rehabilitation and reintegration are important elements of the Ethiopian government’s National Fistula Elimination Plan, which aims to eradicate obstetric fistula nationally by 2020. Healing Hands of Joy is one of the few organizations addressing this need in Ethiopia.

At the inception of E2A’s support, Healing Hands of Joy had one established office in the Tigray region of Ethiopia, and focused on rehabilitation and reintegration work in 14 surrounding woredas (districts). Within the context of the government’s ambitious elimination plan, E2A is now supporting the organization to expand to additional locations near Hamlin Fistula Ethiopia’s regional treatment centers so that Hamlin can easily refer women to Healing Hands of Joy for rehabilitation and support following surgery. The two new locations are in Amhara and SNNP regions of Ethiopia.

In addition to supporting Healing Hands of Joy, E2A is enhancing the monitoring and evaluation capacity of Hamlin Fistula Ethiopia, which runs the Addis Ababa Fistula Hospital, five regional centers, the Hamlin College of Midwives, and the Desta Mender rehabilitation center for fistula patients.

This work is part of the portfolio of activities conducted in conjunction with Pathfinder International’s Integrated Family Health Program Plus (IFHP+).

New E2A policy brief: Model for offering long-acting reversible contraceptives to youth shows promise in Ethiopia

Evidence shows that young people around the world tend to access and use short-acting contraceptive methods much more frequently than long-acting reversible contraceptive methods (LARCs). Training providers to offer LARCs to young people in an environment where they feel comfortable and safe presents a promising approach for reducing the rampant occurrence of unintended pregnancies among those aged 15-24.

A new policy brief from E2A, Testing a Service-Delivery Model for Offering Long-Acting Reversible Contraceptive Methods to Youth in Ethiopia, discusses such an approach. From June 2014 to April 2015, E2A, in collaboration with Pathfinder International’s Integrated Family Health Program Plus (IFHP+), conducted a study at 20 youth-friendly health service sites, split between the Amhara and Tigray regions of Ethiopia. The study tested a model for offering contraceptive counseling and services to young people that includes LARCs.

The service-delivery model tested at intervention sites included:

  • Competency-based skills training on implant and intrauterine device (IUD) insertion, removal, and infection control
  • Refresher training for peer educators to counsel (dispel myths and misperceptions) on safety and effectiveness of LARCs and refer
  • Supportive supervision to youth-friendly service providers

Findings suggest that the service-delivery model had a positive effect on the uptake of contraceptives, including LARCs, and that youth-friendly service providers trained to provide IUDs and implants in a safe and competent way increases the probability that these long-acting methods will be adopted by youth. The study also suggests that there may be a growing pattern among women who have not yet a child to seek contraceptive services, and in particular, to choose long-acting methods. During the study period, 63 percent of women who attended youth-friendly services and a remarkable 81 percent of women who accepted a long-acting method for the first time at intervention sites had not yet had a child.

Non-intervention sites continued to provide the routine youth-friendly services implemented by IFHP+, including training providers to offer youth-friendly services; counseling on all contraceptive methods, including short- and long-acting methods; and offering short-acting methods onsite and referring to the main onsite family planning clinic for LARCs.