Background Paper for Dissemination Seminar, 20 June 2003

Determining and effective and replicable communication-based mechanism for improving young couples' acess to and utilization of RH information and services

PROJECT SUMMARY

The Context:

Young married couples in the villages are difficult group to be motivated for accepting reproductive health services including family planning contraceptives. Suitable community-based intervention package aimed at creating supportive environment and communication channel for responding to their felt needs and their increased participation in family planning and reproductive health decisions are grossly lacking in the country.

Young married couples needs supportive environment and opportunities where they can discuss about their RH issues, gain knowledge about the health implication of early and frequent childbearing, the advantages of routine antenatal check-ups during pregnancy, risk factors associated with pregnancy and childbirth, and knowledge about where to obtain them. They need to be informed about various contraceptives available to them and empowered to communicate effectively with their spouses and friends on contraceptives use to prevent unintended pregnancies. The purposed operations research (OR) study, therefore, will contribute extensively in bridging these program or communication gaps and help in increasing young couples' accessibility to and effective utilization of RH information and services in the villages.

Three organizations viz. CREHPA, NRCS and CEDPA were directly involved in the OR project and testing of intervention strategies in Udaypur district. Research grant for project was received by CREHPA from The Population Council under the USAID funded

FRONTIERS Small Grant Program. The project received technical and ethical approvals from the Nepal Health Research Council (NHRC).

The major part of OR intervention has been through group formation, training, and group interaction and mobilization and networking young couples with community-based health care delivery system. Two models have been tested to target young couples in the villages. The first model (Treatment I) was the formation of a separate youth communication action group (YCAG) in each ward from among young married women under 25 years of age. The second model (Treatment II) was re-activation of Mothers Group (MG) and engaging the MG members in group interaction, training and communication with young couples in the villages. Members of each YCAG and MG selected a leader and a deputy leader from among themselves who were then trained in communicating RH information/messages notably family planning, maternal health and STDs and HIV/AIDS to their respective group members.

All the groups were encouraged to organize collectively, special events and series of talk programs in the villages. Members of each group (YCAG and MG) met at least once a month to share knowledge on family planning, maternal health and STDs and HIV/AIDS. The types, subject matter coverage and scope of intervention were finalized based upon the pre-intervention baseline survey results and recommendations from the two days interactive workshops organized in December 2000 and in subsequent consultative meetings.

Project Summary:

The study seeks to determine an effective and replicable communication-based mechanism for increasing the involvement of community based groups in improving young married couples' (under 25 years) access to and utilization of reproductive health services and information in areas where the Nepal Red Cross Society (NRCS) implement a comprehensive community-based reproductive health program (ENABLE Project) with the support from the Center for Development and Population Activities (CEDPA), a U.S.-based international non-governmental organization.

Since 1996-97, NRCS established communication action groups (CAG) at village level in its three project districts. Members of the group are usually spouses of migrant men and they were empowered with communication skills to negotiate on condom use with their spouses and also discuss openly with their friends about the dual advantage of condoms in context to HIV/AIDS and birth spacing. Likewise, under the government's health system, Aama Samuha or mother's Groups (MG) are formed at the ward (sub-village) level throughout the country. Members of MG are married women and they interact with outreach health workers and health volunteers at their monthly meetings on RH issues and on various social problems of the village.

Three organizations viz. CREHPA, NRCS and CEDPA were directly involved in the OR project and testing of intervention strategies in Udaypur district. Research grant for project was received by CREHPA from The Population Council under the USAID funded FRONTIERS Small Grant Program. The project received technical and ethical approvals from the Nepal Health Research Council (NHRC).

CREHPA was responsible for conducting pre and post intervention surveys, organize interactive workshops and meetings, liaise with FRONTIERS Program of the Population Council and government line agencies (Ministry of Health), prepare training manuals and training plans, monitor the implementation programs and disseminate the results. NRCS trained its project staff and CAG and MG group leaders and execute the interventions in the two experimental sites. CEDPA extended technical guidance to NRCS including maintaining HMIS.

The OR employed quasi-experimental design with two experimental (treatment) and two non-equivalent control groups. One of the two Control groups was in Khotang District. Information on pre and post- tests measurement was acquired through sample surveys and qualitative research methodology.

All ethical aspects concerning confidentiality and informed consent were strictly adhered to at all stages of the OR study. The sample Informed Consent Form developed by The Population Council for IRB Procedures was used for the purpose.

The baseline survey was conducted in October 2000. Interventions strategies were finalized during January - March 2001 and tested (implemented) by NRCS during July 2001 - September 2002. The End-line survey was conducted in October -November 2002 to assess the impact of the intervention. The End-line survey interviewed 401 young married women under 25 years of age from Treatment I, 344 from Treatment II and 268 from Control I. The End line survey was not possible in Khotang (Control II) due to Maoist insurgency. Simple statistical tests (T-test) was performed to compare results between experimental and control groups. The results of the OR study will be presented at a dissemination seminar on June 20, 2003.