E2A Newsletter October-November 2017

Pathfinder Country Directors Present How to Use New E2A Framework to Guide First-Time Parent Programs

On Tuesday, November 14, Pathfinder International Country Directors from Niger, Nigeria, and Tanzania presented how they have applied a framework that E2A is developing to address the sexual and reproductive health (SRH) needs of new parents.

The SRH Lifestages Framework can be used to design and implement context-specific SRH interventions tailored to the needs of specific populations, including first-time parents. The framework outlines different parameters for understanding where an individual or population is in terms of:

  • SRH markers, risks, and vulnerabilities across a lifetime continuum of transitions and stages in sexual and reproductive activity
  • Socio-ecological factors that define the broader context of sexual and reproductive activity—at individual, household, community, and structural levels
  • Relationships and interactions that influence SRH agency, decision-making, and action
  • Gender and social norms that affect SRH decisions and behaviors

The framework allows public health practitioners and program managers to map these elements to ensure that the different factors affecting SRH are accounted for in interventions.

The SRH Lifestages Framework (pictured below) builds on E2A’s original “Reproductive Lifecycle Framework” to lay out the progression of lifestages and transition points over the life of an individual male or female. The SRH Lifestages Framework addresses sexual activity and the complex social factors that affect SRH more clearly than the Reproductive Lifecycle Framework, responding to the need for contextualized SRH programs.

Pictured  (left to right): Patricia MacDonald, USAID; Sani Aliou, Pathfinder/Niger; Joseph Komwihangiro Pathfinder/Tanzania; Farouk Jega, Pathfinder/Nigeria

Young Fathers in Nigeria

“In Nigeria, we used the SRH Lifestages Framework to better understand the situation of first-time parents,” said Dr. Farouk Jega, Pathfinder’s Country Director in Nigeria.

Dr. Jega explained how the framework was used to design a qualitative assessment, which set out to understand more about the population of first-time parents in Cross River State.  He presented assessment findings related to the male partners of first-time mothers. Early findings show that the majority of these fathers are young, 24 to 26 years, fathers for the first time, and that their partners’ pregnancies were not usually planned.

The assessment shows that these young men want to be good fathers. Dr. Jega said that the fathers’ willingness to be involved presents an opportunity to engage them in interventions for first-time parents that can encourage contraceptive use, healthy timing and spacing of pregnancy, healthy gender norms, and maternal and newborn healthcare.

“These young men set quite high standards for fatherhood and themselves, but they didn’t quite feel prepared that they could meet those high standards,” said Dr. Jega. “Despite the knowledge of what an ideal father should be, many felt unprepared to take on that role as a father.”

Based on these findings, E2A is planning to support home visits that include clear components of the SRH Lifestages Framework, and discussion groups with the young men.

Population, Health, and Environment in Tanzania

Dr. Joseph Komwihangiro, Pathfinder’s Country Director in Tanzania, explained how the Tuungane Project—a Population, Health and Environment Program implemented by Pathfinder and The Nature Conservancy—is using elements of the framework to design interventions for first-time parents living within the Greater Mahale Ecosystem.

In this region of Tanzania, he said 80 percent of 10-24-year-old women are mothers, many with their first child.

“These young ladies are not living in isolation,” said Dr. Komwihangiro. He noted that these young women are living within a broader system that often makes it difficult for them to make healthy decisions.

“All of their relations make the individual agent weak and unable to make her own choices,” he continued. “As much as they have learned about the impact of the population on the environment, social norms of the community drive them to still want to have more children.”

He therefore said that the first-time parent interventions in the Greater Mahale will include peer groups of first-time mothers, led by first-time mothers themselves, where they can openly discuss the issues their population faces and learn about family planning and maternal and newborn healthcare.

“These young ladies – the circumstances by which they became pregnant for first time is very touching,” he said. “They need support from the community, and they need support from their peers. This is where idea for the peer support groups came from.”

Peer support groups were also first-time parent interventions supported by E2A in Shinyanga, Tanzania. Based on the needs of the population and findings from Shinyanga, E2A will include livelihoods and income-generation activities as interventions for first-time parents in the Greater Mahale.

Care for the Mother and Her Baby in Niger

In Niger, Pathfinder has supported community health workers to sensitize first-time parents about contraception and maternal and newborn care, and to refer to trained facility-based providers for clinical health services. Using elements of the SRH LIfestages Framework, Dr. Sani Aliou, Pathfinder’s Country Director in Niger, shared how the project has made progress in addressing some of the critical health and social factors that affect first-time parents.

Dr. Sani described how addressing the unique situation of first-time parents in the Zinder region has led to increased uptake of contraception, deliveries at health centers, and antenatal care visits among these young mothers.

In terms of contraception, Dr. Sani said there had been a noticeable shift in method choice. “Before the interventions, pills were most used, and now injectables are first. There has been a steady increase in [long-acting reversible contraception].”

To make sure young mothers have access to a full range of contraceptive methods, the project links community health workers and health facilities, with mobile outreach and health posts in villages.

“This is a very conservative area,” said Dr. Aliou.

The project has engaged religious leaders to gain their support for family planning and reach out to the male partners of first-time mothers. The project also plans to use digital imagery with communities to prompt discussions with individuals who tend to be particularly conservative and reticent.

Following the presentations from the three country directors, Cate Lane, Pathfinder’s lead Technical Advisor on Youth, reiterated how interventions for first-time parents give young mothers a second chance. “There are so many more opportunities if we can help them delay that second pregnancy,” she said. “We can get them back in school, and involved in income-generation and leadership activities.”

A final version of the SRH Lifestages Framework and guide for first-time parent programs will be available from E2A in 2018.

Making the “Demographic Dividend” a Concrete Ambition in Tanzania

Photo by Maren Vespia, Pathfinder International

A study commissioned by E2A and Pathfinder International, with support from USAID/Tanzania, has piqued the interest of decision-makers in Tanzania about how to make smart policy decisions that will allow the country to harness its Demographic Dividend—that is, the economic benefit derived when the ratio of working-age adults significantly increases relative to their dependents.

Tanzania’s population is projected to nearly triple by 2050—to 129.4 million people—if fertility rates remain stable. A Tanzanian woman as an average of five to six children in her lifetime. A high and stable fertility rate over the next 30 years, along with high rates of child mortality, will result in a large population of people who are dependent upon others, a major hindrance to development.

The study—Prospects and Challenges of Harnessing the Demographic Dividend in Tanzania—was produced by the economics department at the University of Dar es Salaam.  It examines Tanzania’s prospects of harnessing the demographic dividend, outlines policy options that can be used by different stakeholders to optimize the country’s potential, and, through different modeling scenarios, explores relative impact of various demographic and economic policies on the country’s development prospects between 2010 and 2050. It specifically highlights how family planning can be better integrated into the overall development agenda.

The modeling shows the effects of the following scenarios:

  • Business as usual (no change in policies)
  • A focus on economic policy shifts with little to moderate focus on family planning and education policies and programs
  • A “combined approach” of economic, family planning, and education policy and programmatic shifts to emphasize all three areas simultaneously

The study shows that the “combined approach” results in significant declines in population and fertility rates, and significant economic growth.

Recommendations in the study report include those to accelerate fertility decline, through:

  • Increasing the national budget for family planning programs and technical capacity to implement them;
  • Reinforcing interventions to reduce child mortality, such as immunizations and better nutrition;
  • Improving the health status of the population through better infrastructure, investments, and addressing pervasive diseases;
  • Fast-tracking education reform for a skilled workforce, including seeing more girls attending school; and
  • Enhancing economic activity and job creation; and improving governance and accountability.

To build on the momentum generated by the study report, Pathfinder/Tanzania is partnering with the Population Action International/Advance Family Planning to orient relevant national stakeholders, including members of the National Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH), on how to use the Demographic Dividend modeling presented in the study report. Through this orientation, Pathfinder will seek to see a focus on family planning in all RMNCAH interventions, and a focus on the concept of Demographic Dividend modeling and family planning in the 2018-19 annual national development plan.

DRC: Stories from the Field

Information about Gender Establishes Balance in the Household

In the next several newsletters, E2A will share stories from its community-based family planning project in Democratic Republic of the Congo. This story depicts how the project has begun to address harmful gender norms.

Kamamba helps his wife Catherine unload food from the market

In Catherine Tshipama’s household, it is not uncommon to find her husband Kamamba cooking for their family of 10.

"With my many births and miscarriages, my health had really deteriorated,” said Catherine. “When my health improved, [my husband] agreed that I would go to distant villages to buy food products. When I do these long distances, he prepares food for the children and for me. He draws water when I am tired or sick. This has contributed significantly to improving the living conditions of our family."

Catherine and Kamamba married over two decades ago when Catherine was 17. But Kamamba’s willingness to take on more household tasks began recently, after Liliane Kabue, a community-based distributor supported and trained through E2A, reached the couple. The idea to more fairly share household responsibilities arose from discussions with Liliane on healthy gender norms.

In most families in DRC’s Kasai Central Province, where the couple lives, things like cooking and gathering water are the woman’s responsibility.

E2A’s gender approach includes integration of gender into family planning sensitization efforts. Community-based distributors, like Liliane, lead activities and discussions that explore if and how different gender norms limit women’s and men’s access to family planning information and services, their communication about health issues, and their roles in making decisions about their own health and the well-being of their families. Community-based distributors make a special effort to engage men, not only to support family planning use, but also to reflect more broadly on how gender norms affect their relationships, choices, and actions in their families and homes.“

"The information received about gender has enabled us to establish a balance in our home where each of us fulfills the tasks of fulfilling our family,” said Catherine.

“I understand one thing: gender [equity] does not detract from my masculinity,” said Kamamba. “In preparing food for my family, this masculinity did not stick to the pan. When I go on the road, they do not call me "ma-man" because I have prepared food or drawn water; they always call me 'daddy.'"

“Before meeting Mrs. Liliane, I did some tasks, but without real conviction,” he continued. “Today, my wife will trade and bring food products home. We do fields together, and all these activities allow us to raise our children well and have them study.”

Through contact with Liliane, the couple also decided to use family planning. "At first, I took lightly any speech that spoke to me about family planning or gender,” said Kamamba. “When Mrs. Liliane made us aware, especially after my wife has several miscarriages, I started to get interested.”

In their 22 years of marriage, Catherine has had 12 pregnancies, 2 of which resulted in miscarriage and 2 children who are now deceased. It was just after her last miscarriage that Liliane reached the couple with information about family planning.