1. Engaging Young and Low Parity Couples in Adoption of FP for Birth Spacing: Opportunities and Challenges Abo Ul Hassan Madni, Research Analyst Dr Tauseef Ahmed, Country Representative Dr Haris Ahmed, Director Programs HHRD November 25, 2013

2. CONTENTS Introduction of Pathfinder International Background Implementation Framework Programmatic Interventions with prime targeting young and low parity men and women – Demand Side – Supply Side Results Outcomes Conclusions and recommendations

3. Pathfinder’s Mission: To ensure that people everywhere have the right and opportunity to live a healthy sexual and reproductive life. For more than 50 years, Pathfinder has delivered vital reproductive health programs that expand opportunities for women, men, and young people in developing countries. INTRODUCTION TO PATHFINDER In Pakistan, Pathfinder started its operations in 1952. - Pathfinder has been working in Pakistan since 2009 on FP & RH in collaboration with the governments of Punjab and Sindh provinces.

4. BACKGROUND Largest youth cohort in Pakistan, 58.5 million (PRB, 2013) Early marriage and social pressure on young and low parity couples for completing family 13% women aged 18 years start childbearing 60% children of women aged 15-19 years and 40% children of women aged 20-24 years are born with less than 24 months Women ill-informed & counseled about family planning and have no concept of birth spacing or methods and side effects Men not involved by the FP Programs

5. BACKGROUND (CONTD.) Low CPR and high unmet need among young and low parity couples Continued unwanted pregnancies among young and low parity mothers Need to focus on young and low parity couples for enhancing Birth Spacing and meeting FP needs through a comprehensive approach / model to achieve MDG 5 Age GroupCPRUnmet Need 15-19720 20-241527

6. IMPLEMENTATION FRAMEWORK WITH PRIME FOCUS ON YOUNG AND LOW PARITY COUPLES Project design concentrated on three aspects: Demand Side (addressing demand generation barriers among young and low parity couples) Supply Side (ensuring quality services and preparedness) Effective Monitoring and Supportive Supervision Pathfinder International initiated a project supported by the Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation “ Scaling-up of Best Practices in FP/RH ” in 26 Union Councils of two districts: Layyah, Punjab and Shaheed Benazirabad, Sindh

7. Client Improved Clinical Skills on IUCD Improving Referrals System Strengthening Supportive Supervision Technical Support & Monitoring PATHFINDER’S MODEL TO ENGAGE LOW PARITY COUPLES

8. DEMAND-SIDE INTERVENTIONS (JAN-DEC, 2012) Prime focus of targeting audience young and low parity married women and men by aiming to promote and popularize three HTSP messages Trained and equipped LHWs with innovative job aids and interactive counseling skills (group and individual meetings) Engaged young and low parity men through community reformer team (religious leader, secondary school teacher and male activist)

9. ACTIVITIES FOR ENGAGING LOW PARITY COUPLES (JAN-DEC, 2012) Female Support Group Meetings: – Meetings 11,359 – Women with low parity (0-2 children) 84,380 Male Support Group Meetings: – Meetings 1,616 – Men with low parity (0-2 children) 17,636

10. SUPPLY-SIDE INTERVENTIONS (JAN-DEC, 2012) Improving Supply Factors – Enhancing quality of services through promotion of infection prevention – Provision of refresher training to health paramedics in IUCD insertion – Ensure ample and smooth supplying of contraceptives Strengthening Systems – Supportive supervision and active monitoring system – Program management involved in supervisory visits

11. Innovative Model (January-December 2012) DEMAND GENERATION Innovative counseling tools Male support group meetings IMPROVING SERVICE PROVISION MVA Training

12. OBJECTIVE OF THE STUDY Share the opportunities and challenges for engaging young and low parity couples in adoption of Family Planning for Birth Spacing Provide an evidence for scaling-up of the initiative

13. Results

14. PARTICIPATION IN SUPPORT GROUP MEETINGS AND FEEDBACK Pathfinder conducted Baseline (December 2011) and Endline (December 2012) in both project districts.

15. PARTICIPATION IN SUPPORT GROUP MEETINGS AND FEEDBACK (CONTD.) Discussing use of contraceptive methods and removing myths and misconceptions 95% of sampled women having seen uterus model out of which 78% find it very useful 83% of sampled women recalled having seen counseling cards out of which 84% find it very useful Recommending FP method based on reproductive history 68% of sampled women reported of LHWs having used contraceptive wheel card - out of which 58% find it useful

16. INTERMEDIATE RESULTS Percent of women reporting correct knowledge of HTSP messages Correct Knowledge about HTSP Messages demonstrated by women End-line Knows best to wait until 18 years for first pregnancy 63% Knows healthy interval between birth to next pregnancy (at least 36 months) 70% Knows healthy interval for next pregnancy after miscarriage (6 months or more) 63% A negligible number of women had correct knowledge of HTSP messages in the baseline survey

17. INTER-SPOUSAL COMMUNICATION AND CURRENT USE OUTCOMES

18. DIFFERENTIAL IN CONTRACEPTIVE USE BY SATISFACTION WITH ATTITUDE OF LHW AND HEALTH FACILITY SERVICES

19. IMPACT OF PROVISION OF FP METHODS BY LHW ON CURRENT CONTRACEPTIVE USE

20. CURRENT USE

21. Change in behavior starts with younger and low parity women Factors that break the barrier to contraceptive use among young and low parity couples – Community mobilization especially male involvement is critical for demand generation through imparting correct knowledge of HTSP messages – Inter-spousal discussion on HTSP messages – Satisfaction with attitude of LHWs, health facility services and provision of FP methods by LHWs Department of Health, Punjab has initiated real time scale-up of the initiative in neighboring UCs and districts with technical assistance from Pathfinder There is HOPE that even a little attention to FP can bring change in behaviors among young and low parity couples FINDINGS FROM THE FIELD

22. CONCLUSIONS HTSP/FP messages when properly introduced (in terms of benefits to women) is readily embraced as a maternal health measure For engaging young and low parity couples to adopt FP for birth spacing, the need is to: – Holding extensive sensitization – Enhancing inter-spousal discussion – Increasing satisfaction couples with attitude of LHWs and services of health facility – Providing of FP supplies by LHWs

23. …. AND RECOMMENDATIONS Make reaching out to young mothers and low parity women a priority Essential to link FP to health benefits and outcomes to ensure young couples adopt FP for spacing pregnancy Sustainability of advocacy efforts to motivate young and low parity couples to adopt FP for birth spacing especially with involvement of men Provision of family planning supplies at facilities Assurance of Continued Quality of Services

24. twitter.com/PathfinderInt facebook.com/PathfinderInternational Youtube/user/PathfinderInt Pathfinder International House 579, Street 35 E-11/3 Islamabad, Pakistan Phone: +92-51-222 1949 Web: www.pathfind.org CHANGE STARTS HERE