E2A Newsletter, March 2016

Whose Norms? : E2A releases second behavior-change film for use with youth-friendly service providers in Niger

Young people around the world often identify service providers’ negative attitudes toward them and unfriendly behaviors as some of the main barriers that limit their access to contraceptive services.

In Niger, it is no different. Although the majority of Nigerien girls marry before they turn 18, their access to sexual and reproductive health services that include family planning counseling and access to a wide range of contraceptive methods is still extremely limited. According to the 2012 Demographic and Health Survey in Niger, just 4 percent of adolescent girls, aged 15-19, and 12 percent of young women 20-24 years old, were using a modern contraceptive method.

“Whose Norms,” a new film created by E2A and produced by Nigerien film company Maggia, aims to spark reflection, dialogue, and action among service providers in Niger that will enable them to offer quality youth-friendly sexual and reproductive health services. Produced within the context of E2A’s University Leadership for Change project in Niger, “Whose Norms?” is the second in a suite of three behavior-change films. The first, entitled “Binta’s Dilemma,” has been used to encourage conversations among young Nigeriens about culturally sensitive topics, including contraception, unintended pregnancy, and the societal pressures on young women to bear children once they are married. “Whose Norms” was based on qualitative data about barriers and facilitators for offering youth-friendly sexual and reproductive health services collected from service providers in Niamey using Pathfinders’ Pathways to Change methodology.

The film will be used as part of a comprehensive behavior-change approach, which applies Pathfinder’s Reflection and Action for Change methodology (REACH) to engage young people, health providers, community members, and others to identify and prioritize behavioral outcomes that can improve health and well-being in their communities.

“Whose Norms” was validated by the Nigerien Ministry of Public Health and Ministry of Higher Education, Research and Innovation in December 2015. It will now be used in Niamey and regions across the country to improve access to and quality of youth-friendly sexual and reproductive health and family planning services.

E2A to begin implementation of Saving Mothers, Giving Life interventions in Nigeria

This week, E2A will begin implementing interventions to improve maternal and newborn health services at select hospitals and health centers in Cross River State, Nigeria. Medical officers, nurses, midwives, and Community Health Extension Workers will participate in trainings, which will give them lifesaving skills they can use with women just before, during, and immediately after delivery, and with their newborns.

The trainings will kick off E2A’s work under the Saving Mothers, Giving Life program. They follow a comprehensive health facility assessment conducted by E2A in 18 Local Government Areas of Cross River State late last year. From that assessment, E2A identified 73 health facilities (20 private for-profit health centers, 41 public health centers, and 12 public hospitals) where Saving Mothers, Giving Life interventions will be implemented.

The trainings will contribute to ensuring that all health centers and hospitals can provide the seven functions of basic emergency obstetric and newborn care services: antibiotics, anticonvulsants, uterotonics, manual removal of the placenta, assisted vaginal delivery, removal of retained products, and newborn resuscitation. In addition to the aforementioned functions, all hospitals are expected to conduct caesarian deliveries and blood transfusions related to labor and delivery.

Gleaned from Saving Mothers, Giving Life pilot programs in Uganda and Zambia, the program in Nigeria will replicate a package of evidence-based, comprehensive maternal and newborn health interventions. The pilots in Uganda and Zambia resulted in a 35 percent decline in mothers dying as a result of childbirth at participating facilities. In Nigeria, the interventions are expected to lead to a 15 percent reduction in maternal mortality and a 10 percent reduction in newborn mortalities in the 18 Local Government Areas of Cross River State where the initiative is operating.

A family planning believer in Tanzania reaches out to first-time parents

E2A is now implementing interventions in Tanzania to reach first-time parents with sexual and reproductive health services that include a wide range of family planning methods. Mary Edwards, a community health worker profiled below, is a part of that effort.

When Mary Edwards was a young woman, crossing the bridge from adolescence to adulthood, she knew nothing about contraception, and at age 18, she had her first child.

"I had children continuously without using any family planning method,” she said.

It was not until after Mary’s fourth birth that she began using oral contraceptive pills. After one year of using the pills, she decided to have a fifth child who died shortly after childbirth—a death she attributed to use of the oral contraceptive pills.

“I got a child with big head who then passed away,” she said. “People said that this was directly associated with the family planning methods I used, so I decided not to use a method anymore, and within few months I got an unexpected pregnancy.”

“I asked a doctor if the death of my baby was related to the use of contraceptives and he explained to me that it was not,” she said. “I decided, then, to try once more the contraceptives and I used injectable for six months, then I went for a tubal ligation."

Today, as a 45-year-old widow and mother of five, Mary works with Pathfinder International’s E2A-supported community-based family planning program in the Shinyanga District of Tanzania as a community health worker.

“Before joining this program, I still believed in myths and misconception about contraceptives,” said Mary. “After the trainings and the experience I am having on family planning, I have gained knowledge and always speak about what I know through counseling sessions I am conducting in my village.”

“I have 176 clients using family planning," Mary said proudly.

E2A’s work in Tanzania has included an effort to integrate Standard Days Method into the contraceptive method mix in Shinyanga—an area with a significant number of Catholics. Standard Days Method has been fluidly integrated into family planning counseling and methods provided by community health workers like Mary, largely through use of a mobile application. The mobile application guides the community health workers through a well-defined protocol to educate the client about all available methods, and draws on the client’s fertility intentions and personal preferences to enable her to choose an appropriate method.

More recently, E2A has started to develop and apply specific approaches to reaching first-time parents—young women under the age of 25 and their partners with one child—with reproductive health and family planning services. This approach focuses on expanding method choice for young mothers. The project has trained 40 health providers to provide long-acting reversible contraceptives (implants and intrauterine devices).

Mary, who did not know anything about using contraception to space and delay pregnancies when she had her first child at age 18, is part of this effort.

"I would like to tell the world, especially young mothers, that family planning is very important as it will help them to fulfill their dreams and be able to take care of the children that they can and plan to have,” said Mary. “I always talk to my four daughters about the necessity of spacing.”

Mary said that all of her daughters, except the youngest, are now using contraceptives.

“I am the example of failure to plan,” said Mary, “and I struggled a lot to take care of my children in the absence of their father. I do not want anyone else to suffer like me."