COMMUNITY-CENTERED FAMILY PLANNING PROGRAM FOR THE PASTORALIST REGION:
SMART START FAMILY CIRCLE.
Author: Yonatan Tamiru, Communication and PR Specialist, PSI Ethiopia and Fana Abay, Marketing and Communications Director, PSI Ethiopia
Background
Over the years, global access to and utilization of modern contraceptives has steadily increased. According to the 2019 World Health Organization data, the worldwide contraceptive use rate for individuals of reproductive age (15–49 years) was 76.5%. This trend is also reflected in Ethiopia, where contraceptive use rates among married women and adolescent girls of reproductive age have increased from 35% (EDHS 2016) to 41% (EDHS 2019). However, there are disparities among regions due to socio-cultural and religious factors. For instance, in the Afar pastoralist community, only 12% of individuals of reproductive age use contraceptives, compared to 49.5% and 38.9% in the Amhara and Oromia agrarian regions, respectively (EDHS 2016).
As part of the Road Map to Integrating Smart Start in Ethiopia (RISE) Program, the Ethiopian Ministry of Health, in partnership with Population Service International Ethiopia, integrates the acclaimed “A360’s Smart Start” program into primary healthcare across Ethiopia, particularly in pastoralist regions. A people-centered approach was used to customize Smart Start program to pastoralist communities, allowing clients, healthcare providers, community influencers, and gatekeepers to tailor the program to their unique traditions and beliefs.
Adapting of Smart Start’s “Hook” for the Pastoralist Community
In agrarian regions of Ethiopia, Smart Start employs financial planning and goals as a catalyst for discussing sexual and reproductive health, family planning, and contraceptives with newly married adolescent girls/couples. However, linking family planning and contraceptives to financial goals did not resonate with the pastoralist community, which believes prosperity comes from having many children. Prototypes were developed and assessed based on insights gathered from married adolescent girls, couples, health workers, and community influencers to improve access to non-stigmatized sexual and reproductive health information and services. After multiple rounds of testing and learning, the Smart Start Family Circle model was developed. This solution facilitates access to friendly sexual and reproductive health information and services for married adolescent girls and couples in pastoral communities, free from stigma and discrimination.
The Family Circle process includes the following steps:
- Smart start family circle training is provided to the health extension workers and health professionals at the local health post to enable them to recruit married adolescent couples from their respective Kebeles.
- Community health extension workers and RISE program staff conduct home visits to inform married adolescent couples, community influencers, and gatekeepers about the RISE Program and invite them to a community launch event.
- The Woreda health department, community influencers (religious and clan leaders, Ulatinas), Youth Innovation Champions, health extension workers, Smart Start Navigators, and couples attend a community launch event. This event lays the foundation for an open dialogue about sexual and reproductive health, family planning, and contraceptives, aiming to reshape social norms that support decision-making among married adolescent girls and couples.
- Meetings with community influencers emphasize the importance of family planning for the health and well-being of married adolescent girls, mothers, and children. These meetings equip community influencers with the skills and confidence to dispel myths and misconceptions about family planning and modern contraceptives in their community.
- Married couples receive comprehensive counseling from Health Extension Workers on the importance of family planning for a healthy and well-organized family life. They are presented with a range of contraceptive methods to choose from.
EVIDENCE GENERATION FOR THE SMART START FAMILY CIRCLE MODEL
From August 2022 until April 2023, adaptive implementation was conducted in three woredas (Afambo, Aysaita, and Elidar) to assess the impact of the Family Circle model. The results were remarkable: contraceptive use increased from 453 users in the same period of 2022 to 714 users in April 2023 after the introduction of RISE/Smart Start. Moreover, societal perceptions regarding sexual reproductive health and modern contraceptive methods are evolving, dismantling long-standing religious and cultural barriers while improving knowledge and acceptance. Religious and clan leaders have become active proponents of family planning and modern contraceptive methods to safeguard the well-being of young girls, mothers, and children in their communities. Witika Nore, Deputy Head of the Afar Regional Health Office, noted, “RISE’s introduction of the family circle approach has proven successful in addressing the challenges posed by deeply ingrained cultural and religious beliefs.”
The Family Circle model, which actively engages local community members in program design and implementation, has effectively enhanced access to and utilization of family planning services in the Afar region.
WHAT IS NEXT
The RISE program is expanding the implementation of the Family Circle model to the remaining twelve woredas in the Afar region. The goal is to provide comprehensive sexual and reproductive health information and services to married adolescent girls and couples in 465 Woredas across Ethiopia.
