1. Mobile outreach dismantles barriers to the adoption of long term family planning methods in Togo Awa Tchedre, PSI/Togo Family Planning Project Coordinator Danielle Naugle, Peace Corps Volunteer

2. page 2 National Context Human Poverty Index of 36.6% (ranks 117 out of 135 countries) 18.6% of the population is not expected to survive to age 40 46.8% of adults are illiterate 41% of the population does not use an improved water source 26% of children under 5 are underweight

3. page 3 Maternal and Child Health National Fertility Rate: 5.6 lifetime births Maternal mortality rate: 478 per 100,000 live births Infant mortality rate: 91 per 1,000 live births Modern contraceptive prevalence rate: 11% (2006) Unmet need for family planning: 41% (2006) 40% of women (>30) have had one or more abortions

4. page 4 Family Planning Project 2008-2010 Goals: Train service providers Expand the range of available family planning methods Inform the population of their contraceptive options

5. page 5 Formative Research Results 2009 Tracking Results Continuously Survey of 3,979 women (ages 15- 49): Barriers: –Distance to clinics –Cost of certain methods –Perceived lack of male support –Fear of side effects

6. page 6 Intervention 2, 3-month cycles of mobile outreach 234 PSI trained service providers 30 public district hospitals conducted 2 mobile outreach days per month

7. page 7 Mobile outreach strategy reduces risk by diminishing: Monetary costs Psychological costs Social costs

8. page 8 Reducing Monetary Costs –Reduce product/services fees from $3.00 (IUD) and $7.00 (implant) to $0.40 –Eliminate high transportation costs

9. page 9 Reducing Psychological Costs Provide services at familiar local clinics Correct common misconceptions Allay the fears of potential clients

10. page 10 Reducing Social Costs Opportunity to reach male partners and convince them of the many benefits of family planning Several women from any one community adopt a LTM at the same time creating a circle of social support for users Clients do not feel “alone” in their choice

11. page 11 Results 30 District Hospitals conduct 2 mobile outreach days a month for a period of 3 months – First cycle: August – October 2009 956 IUDs 2,521 implants – Second cycle: February – April 2010 371 IUDs 5,291 implants

12. page 12 Mobile Outreach vs. Static Network Centers

13. page 13 Long Term Impact Mobile outreach can be effective in overcoming barriers to the immediate adoption of long term methods By giving rural consumers the opportunity to try a LTM at low monetary and psychosocial costs, we hope to catalyze the diffusion of LTMs in rural areas

14. page 14 Challenges Rain and bad roads limit mobile outreach activities to the dry season National stock-outs of IUDs affect activities; inadequate product to satisfy demand It still remains to be seen whether clients will eventually be willing to pay the relatively high monetary costs associated with LTMs in the future

15. page 15 Implications Mobile Outreach could be expected to generate similar results in places where there is/are: – low density of service providers – high cost of access to information and products – misconceptions surrounding modern contraceptive methods – lack of male support for family planning – low penetration of modern contraception – target populations that are difficult to reach through traditional channels

16. page 16

17. Presenter Disclosures Awa Tchedre (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Employed by Population Services International/Togo (PSI-Togo) page 17