Population Council Research that makes a difference

To respond to the challenge of supporting women in achieving healthier birth intervals of at least two years, the Population Council's USAID-funded FRONTIERS program, in collaboration with the Egyptian Ministry of Health and Population (MoHP) and the NGO Social Planning, Analysis and Administration Consultants, conducted an operations research (OR) study to compare the acceptability and effectiveness of two clinic and community-based behavior communication change (BCC) and service-delivery models:

• The "health services" model communicated birth spacing and postpartum family planning (PPFP) messages to women via health workers during their prenatal and postpartum care visits.
  
  
• The "community awareness" model, in addition to providing messages to women, involved an awareness-raising component that focused on men and trained community leaders to communicate birth spacing and PPFP messages.
  
  

The study used an experimental design in 20 health facilities in six health districts, three each from Assiut and Sohag Governorates of Upper Egypt. One district in each governorate was randomly assigned to implement a model or to serve as a control site by providing standard care only.

Sources of data for this study included:

• Exit and home interviews with low-parity pregnant women at 4 months and 10–11 months postpartum (1,416 women total);
• Structured interviews with physicians, nurses, and family planning outreach workers;
• In-depth interviews with local Ministry of Health and Population (MoHP) managers and supervisors;
• Focus group discussions (FGDs) with community leaders;
• FGDs with husbands of low-parity women; and
• Service statistics on utilization of maternal and child health and family planning services.
  
  

The study demonstrated that using these models to provide birth spacing and PPFP messages to low-parity women and their husbands was both feasible and acceptable. Both models proved effective in changing knowledge and attitudes toward healthy timing and spacing of pregnancy (HTSP) and in enhancing use of PPFP at 10–11 months postpartum. Both models were associated with increased utilization of services, especially of family planning, by women who had only one child. However, a fear of contraceptive side effects continues to be a major concern among women and men in all groups and is an obstacle in achieving healthy birth intervals.

To build upon the success of the OR study, the Council was awarded additional funding in 2009 by the USAID-funded Extending Service Delivery (ESD) project. The purpose was to scale up the original intervention to all of Assiut and Sohag Governorates. Activities occurred in two phases: Phase 1 (June 2009–November 2010 ) aimed to scale up the intervention to eight additional districts, and Phase 2 (December 2010–April 2011) aimed to scale up into the remaining districts and build MoHP capacity for scale-up in other governorates.

Activities included: 

• Revising and updating protocol for providing messages around HTSP for pregnant and postpartum women;
• Training of trainers for family planning and maternal and child health managers and supervisors;
• On-the-job training and job aids for clinic staff;
• Providing information, education, and communication materials to clients;
• Monitoring and supervision;
• Educational seminars for husbands;
• Steering committee meetings; and
• A national orientation and dissemination workshop.