«September 2008 This publication was made possible through support provided by the, U.S. Agency for International Development, under the terms of ...»
Report on the Qualitative Assessment of
Community Based Approaches to Promote
Smaller Families and Family Planning Among
Men in Uganda
This publication was made possible through support provided by the, U.S. Agency for
International Development, under the terms of Contract No. ……………………… The
opinions expressed herein are those of the author(s) and do not necessarily reflect the
views of the U.S. Agency for International Development
Table of Contents Acknowledgements
1.2 Objectives of the Assessment
1.3 Brief Description of Communication Tools
1.4 Assessment Methodology
2.0 Assessment of the Effectiveness Communication Tools
2.1 Assessment of Tools Used in Community Based Approaches
2.1.1 Assessment of Community Based Radio Programmes
2.1.2 Assessment of Worksite discussions
2.1.3 Stepping Stones Sessions
2.1.4 Competitive sporting events
2.2 Assessment of Tools Used in Men Only Seminars
2.2.1 Forum Theatre Drama Shows
2.2.2 Distribution of IEC Materials
2.2.3 Competitive Sporting Events
2.2.4 Seminars and Training Sessions
3.0 Effects of the Community Based Approach on Specific Attitudes, Knowledge and Practices on Family Planning
3.1 Provision of Family Planning Information and Effects on Common Fears, Myths and Beliefs about Family Planning
3.2 Effect on Values Held about Family Size
3.3 Effects on Couple Communication
3.4 Effect on Family Planning Practices
3.5 Effect on Attitudes towards Role of Men on Family Planning
4.0 A Comparison of the Attitudes, Knowledge and Practices on Family Planning Among Men Who Were Involved In Interventions and Those That Were Not Involved
4.1 A Comparison of Attitudes about the Population Crisis
4.2 Perspectives on Ideal family size
4.3 Family Planning decisions at Family Level
4.4 Common Question, Beliefs and Concerns on Family Planning
4.5 Men’s Access to Family Planning
5.0 Assessment of the Effectiveness of the Processes Involved In the Organization of Project Activities
5.1 Processes Involved in Project Implementation
5.2 Processes in Implementation of Communication Tools
6.0 Lessons Learned
6.2 Lessons learned
6.3 Implications for Scaling Up
ANNEX I: STUDY AREA AND FGD’s DONE
ii Acknowledgements The consultant would like to thank: Health Communication Partnership, for the opportunity to participate in this assessment. In particular, Donna Sherard, Barbara Katende, Dr. Robert Kalyebara and Emma Kayongo who provided constructive and helpful advice and guidance; the entire research team who collected data and prepared transcripts for the assessment; staff of Plan Uganda and Reproductive Health Uganda as well as all the community mobilizers that helped us find respondents. Special recognition goes to all the men and women who took part in this study and gave generously of their time to discuss their experiences frankly and openly.
Agatha Kafuko, Consultant
iv Executive Summary Health Communication Partnership has been working with the Uganda Ministry of Health Reproductive Health Division and various civil society partners to promote smaller family size, men’s involvement in family planning decisions and increased utilization of modern family planning methods. Accordingly Health Communication Partnership provided technical assistance to selected partners to develop and test community based approaches to promote smaller families and family planning among men. A pilot project to develop and test community based approaches was implemented in collaboration with Plan Uganda. In addition, one day Men Only seminars, aimed at providing information and arousing men’s interest in family planning, were held in selected districts. This qualitative study follows the implementation of these interventions and aims at assessing the effectiveness of the community based approaches and documenting lessons to inform the design of future communication campaigns targeting men at the community level. The specific objectives were to: (1) assess the effectiveness of the various communication tools from the perspective of targeted men, (2) assess the effectiveness of processes involved in the organization of project activities and delivery of family planning messages (3) assess the effects of the community based approach on specific attitudes, knowledge and practices on family planning (4) compare the attitudes, knowledge and practices on family planning among men who were involved in the pilot community based interventions and Men Only seminars with those that were not involved and (5) identify and document lessons from project implementation. Data for the assessment was collected in five districts namely Kampala, Luwero, Tororo, Mbarara, and Soroti through the use of focus group discussions.
The communication tools were interactive, providing an opportunity for dialogue and feedback. Community based radio programmes, worksite discussions, competitive sporting events and communication tools used in the Men Only seminars were successful in mobilizing men and disseminating information on family planning. The effectiveness of the Stepping Stones approach was however hampered by the inadequate time.
Although not universal, men who were involved in project activities as well as their partners reported improved couple communication. Overall, there is a change in the beliefs and attitudes among men towards family planning. Values hitherto held about large family size and children are being questioned. The safety and side effects of contraceptives remains a main concern for men and their partners. Some of the resource persons were not very knowledgeable and as did not adequately respond to questions and concerns raised by men, particularly with regard to contraceptives. Focus group participants emphasized couple oriented communication, for better results.
The assessment results show that men have the desire and willingness to take a lead role in making decisions and supporting their partners in family planning. Men’s effective participation in family planning decision making is however, hampered by lack of information, inadequate couple communication and values regarding family size. The communication tools that were used in the interventions provided men with the opportunity to access accurate information on family planning, and the motivation to initiate discussions on the same with their partners. The assessment results show that
Implications for Scaling up
• Mobilization of project activities should be done in advance to get more men opportunity to participate.
• The design of the project should consider targeting men and women together as couples.
• There is need for capacity building for all resource persons and volunteers who implement the community based approaches to improve their skills and knowledge and equip them to respond adequately to questions that may emerge during the communication activities.
• The community based approaches to promote family planning among men should integrate as a key component, messages that address concerns regarding the safety and side effects of family planning.
1.0 Introduction This is a report of a qualitative assessment of a pilot project that was implemented to develop and test Community Based Approaches (CBA) to promote smaller families and family planning among men in Uganda. The assessment also covers Men Only seminars which were aimed at informing men and stimulating their interest in family planning. The CBA and Men Only seminars were part of Health Communication Partnership’s (HCP) collaboration with Ministry of Health (MoH) towards the revitalisation of family planning communication campaign.
1.1 Background In Uganda, family planning programmes have been traditionally directed towards women, since it is women who become pregnant and face the health risks associated with pregnancy and childbirth. Women presumably have the greatest motivation to prevent unwanted pregnancies (Kaida et al 2005). Further, women are more likely to be in contact with the health care system because of their overall responsibility for family health, especially with regard to infants and children under the age of five.
Uganda remains with one of the highest Total Fertility Rates in the world at 6.5 (UDHS 2006). The contraceptive prevalence rate in Uganda among married women is 24 percent.
Although this shows an improvement from 16 percent, it is still relatively low for a country with a high fertility rate. The low levels of utilization of family planning have in part been attributed to the limited involvement of men in family planning. There is limited involvement of men in either receiving or providing reproductive health information in sub-Saharan Africa, and yet the men play a crucial role in decision-making about the use of contraceptives (Mbizvo & Adamchak, 1991). Studies have shown that the limited impact of many family planning programmes can be attributed to a continued neglect of men as both agents and clients of family planning (Khalifa, 1988). The neglect of men with respect to their role in family planning has contributed to a situation in which men have remained passive or non-participatory in reproductive health-related matters. A qualitative research on men’s participation in family planning in Mpigi by Kaida et al.
(2005) showed that despite the fact that men have limited knowledge about family planning, they want to be involved in family planning discussions and information sharing. This finding contradicts the general notion that men are not interested in family planning issues. Men’s desire to gain more knowledge about family planning was attributed to the need to make them competent partners in discussions with their spouses and health workers about family planning. In this study, men attributed their lack of knowledge on family planning to lack of opportunity to learn more about family planning matters and not a lack of interest in family planning. A quantitative study in Mpigi demonstrated that approximately 90 percent of married men were interested in gaining more knowledge about family planning (Kaida, 2001). The UDHS (2006) shows that 81 percent of married women reported that their partners knew that they were using contraceptives. The UDHS also shows that only 5 percent of women who did not intend to use contraceptives gave partner opposition as the factor that influenced their behavior.
There was a lack of spousal communication about family planning which men attributed 1 to their poor understanding of family planning knowledge and to the reluctance of (primarily female) family planning providers to include men in family planning counseling and other programme activities (Kaida et al. 2005). The UDHS (2006) indicates that 45 percent of married women did not discuss family planning with their husbands at any time in the year preceding the survey, while 30 percent discussed it once or twice, and 26 percent discussed the issue three or more times. The survey showed that younger women and those in their 40’s were likely not to have discussed family planning.
The National Population Policy (1995) is in part aimed at enhancing the role of men in planning for the family, a role that includes the promotion and utilization of family planning activities. Increasingly, programmes to facilitate the increased involvement of men in family planning have been initiated in Uganda. In 2006, HCP began working with the Uganda MoH, Reproductive Health Division and other civil society partners to promote smaller family size, men’s involvement in family planning decisions and increased utilization of modern family planning methods. HCP provided technical assistance to the MoH Family Planning Revitalization Working Group to develop and implement a national communication campaign with the theme “promote smaller, healthier and more prosperous families in Uganda.” Against this background, HCP, in collaboration with other partners, and with funding from USAID, undertook an initiative to develop and test Community Based Approaches (CBA) to promote family planning among men in Uganda. The community-based campaign is designed to achieve three
objectives pertaining to service providers, men, and community, respectively as follows:
a) to reduce misinformation, fears and misconceptions regarding family planning by improving the quality of education and counseling by service providers; b) to ensure that men have accurate information about family planning and value smaller families as a means to a better quality of life and; c) to strengthen community mobilization for family planning and smaller families, with a particular focus on men. The CBA targeted men aged 18 – 35 years and were conducted in collaboration with Plan International in Kampala, Luwero and Tororo districts over a four month period (June–Sept 2007), with Reproductive Health Uganda (RHU) as the local implementing partner. In 2008, HCP worked with other partner organizations to hold one day Men Only seminars in seven districts namely Arua, Luwero, Mbarara, Masaka, Soroti and Tororo. The Men Only Seminars were aimed at providing men with information and stimulating their interest in family planning. It is against this background that HCP commissioned this qualitative study to assess the effectiveness of the communication tools that were used that were used in the CBA and Men Only seminars.
1.2 Objectives of the Assessment The qualitative study was aimed at assessing the effectiveness of the community based approaches and draw lessons to inform the design of future programs. The specific
objectives were as follows:
(i). An assessment of the effectiveness of the various communication tools from the perspective of men who were involved in the initiatives (ii). An assessment of the effectiveness of the processes involved in the organization of project activities and delivery of family planning messages from the perspective of the partners and men who were involved in the project