THE CONTRIBUTION OF THE RISE PROJECT TO THE UPTAKE OF FAMILY PLANNING FOR MARRIED ADOLESCENT GIRLS AND WOMEN
INTRODUCTION
The roadmap to Integrate Smart Start in Ethiopia (RISE) is one of PSI Ethiopia’s projects which evolved from the A360 (Adolescent 360) project implemented in ten woredas of three zones in the Amhara Region. (Awi, South Gondar, and North Wollo zones).
Smart Start is a demand creation approach developed by the A360 project to reach married adolescent girls and women to increase the uptake of Family planning services and products. Smart Start uses financial planning as an entry point to engage these adolescent girls and women in planning their future and achieving financial stability by helping them understand the benefits of Family Planning and contraceptive products to help them plan the timing of their first birth and the number of children they plan to have in accordance with their financial capabilities and their family planning goals.
The Federal Ministry of Health (MoH) and Regional Health Bureaus decided to scale up RISE and integrate it with the government’s health care system because of the success of RISE’s Smart Start Approach and a common understanding of RISE’s role in enhancing family planning contraceptive methods uptake among rural married girls, an underserved segment of the population.
The main goal of the RISE project is to reach one million married rural girls aged 15 to 19 years with the Smart Start initiative and help them make informed decisions on modern family planning and contraceptive methods.
Following the endorsement of the Smart Start approach by MoH, in 2021 RISE began implementation in eighteen woredas in the Amhara region and plans to expand to 106 woredas in the next five years.
THE CHALLENGE
Married adolescent girls in rural Ethiopia live far away from their parents’ households and move closer to new their in-laws, where they find themselves to be in an unfamiliar area far from the people, they were closest to.
This creates a social vacuum without close friends and relatives to openly discuss and share their feelings and ask for guidance. In most cases, new brides are under close supervision and custody by their in-laws who rarely encourage these girls to move freely and socialize, go to markets or even health centers unless they absolutely must. As a result of this isolation and supervision, They often become pregnant at an early age. Sometimes they give birth before familiarizing themselves with nearby health facilities where they can get access to family planning and related health services.
This case study shows the contribution of RISE in increasing the uptake of Family planning contraceptive methods among rural married young girls aged between 15 to 19 years.
We compare four zones (2 where a RISE intervention took place and two non-RISE zones) sharing, similar socio-, economic and cultural characteristics. West Gojjam and Central Gondar are RISE intervention zones. East Gojjam and Awi are taken from non- RISE zones and are used to compare contraceptive method uptake and effectiveness.
ACTIONS TAKEN TO RESOLVE THE PROBLEM
To reach adolescent girls with information and access to modern contraceptives we undertook the following activities:
Providing training for Health Extension Workers (HEW) on Smart Start counseling, including its importance, implementation, and strategies for identifying and reaching married rural girls.
Providing orientation for community leaders, religious leaders, Women Development Army members, and other influencers in the community on the importance of Smart Start.
Mapping and mobilization of married rural girls (15–19) through door-to-door movement with the help of WDA (Woreda Development Agents) and community leaders.
Conducting Smart Start counseling sessions through Health Extension Workers to make sure that the counseling was couples counseling.
Providing modern contraceptive methods of their choices at health facilities.
RESULTS/IMPACT
Considering the equal number of rising intervention and nonintervention woredas (18 each), consistent technical assistance from regional health bureau and lower-level structures, and fair distribution/supply of family planning products, six months of data from 2021 shows that in areas without rising, family planning uptake declined by 34%. Areas where RISE was active saw family planning uptake increase by 9.5% (as compared to FY2020)
RECOMMENDATIONS
Further studies will need to be conducted to assess factors that affect the uptake of contraceptive methods of married adolescent girls. The project should scale up the implementation of smart start strategies in the remaining sites within the project period. Future research should aim to learn and understand the quality of the services girls receive from health facilities and understand the level of customer satisfaction. The level of integration of the Smart Start Approach in the health system should be reviewed and tailored support should be given by the RISE project at all levels of the health care system until the Smart Start Approach is fully integrated and functional.
