1. Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Ian Askew Population Council

2. Why Mobile Outreach? In principle it…. Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International2 Increases access to clinical methods for populations living far from qualified personnel and facilities Enhances acceptability for family planning generally, and clinical methods specifically Improves choice of methods available to better meet individual needs Offers safe, quality services through various assurance mechanisms and routine client follow-up Reduces costs of travel, time from work and commodity price (through subsidization)

3. Evaluation Methods Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International3 Where? -235 sites, 4 districts of Rajasthan State, India -26 sites, 4 provinces of Zimbabwe Who and when? -India: 875 TL clients; 402 IUD clients Pre-procedure and exit interviews; 15-day interviews 90 day interviews with IUD clients -Zimbabwe: 610 Implant clients; 48 IUD clients; 7 TL clients Client-provider observations; exit interviews; 15-day interviews

4. Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International4 Findings

5. Who accesses these services? Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe India Married, rural women, mostly housewives Two-thirds TL clients in late 20s; Wider age range for IUD clients 60% TL clients have 3+ children; 60% IUD clients have 1-2 children 30-50% no schooling; 31-53% secondary+ education 80-82% low caste families 44% (TL) and 61% (IUD) high standard of living Most women never used modern method previously Marie Stopes International5 Zimbabwe One-quarter unmarried, ¾ rural women Wide age range, including 12% under 20 years Average parity 3; 25% have 4+ children 60% secondary+ education One half are housewives 13% living on $2.50 or less per day All women had previously used a method (pills); 62% unintended pregnancy while using

6. Who accesses these services? Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe India Day of procedure: Any side effect (mostly pain): –TL 35% –IUD 23% Moderate-severe pain: –TL 3.4% –IUD 1.2% 15 days post procedure: Any side effect (mostly pain): –TL 15% –IUD 21% Moderate-severe pain: –TL 3.9% –IUD 5.0% Marie Stopes International6 Zimbabwe Day of procedure: Pain: –Implant: 32% (17% moderate) –IUD: 35% –TL: All (1/7 moderate) Bleeding: –All cases very mild or mild, except 1 IUD (severe) 15 days post procedure: Moderate pain: –Implant: 1% –IUD: 10% –TL: 1/7 Bleeding: –1/48 IUD moderate –1/7 TL severe

7. IUD discontinuation at 90 days (in India) Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International7 Among the 32 discontinuing, 15 switched to: TL (5), pill (7) and condom (3) Among the 361 continuing, 46% reported side effects

8. What quality do they receive (in Zimbabwe)? Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International8

9. Conclusions Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International9 A.Mobile outreach services can effectively reach underserved populations to expand range of services B.Meeting the needs of women with a range of socio- demographic characteristics C.Acceptable levels of adverse events experienced D.In India, IUD discontinuation rate of 8% at 90 days is relatively high, and only half of women switched method E.In Zimbabwe, quality of care is generally good, with most women receiving an integrated service

10. Your questions… Evaluations of MSI’s Mobile Outreach Services in India and Zimbabwe Marie Stopes International