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Saplings and Contraceptives: Results From a Population, Health, and Environment Project in Kenya
May 28, 2015 By Theresa Hoke
East African countries like Kenya have made great strides in recent decades in increasing access to modern contraception, leading to marked declines in fertility rates. But disparities remain.
The 2014 Kenya Demographic and Health Survey showed that rural women have a total fertility rate of 4.5 children per woman versus 3.1 for urban women, and the poorest women have more than twice as many children on average than the wealthiest. Meanwhile, unmet need for contraception among poor and rural Kenyan women is higher than any other groups. Clearly, innovative solutions are needed to support women and couples in poor, remote rural areas in achieving the number and timing of pregnancies they desire.
FHI 360 was pleased to collaborate with the Green Belt Movement in testing one such solution. Founded in 1977 by the late Nobel laureate Wangari Maathai, the Green Belt Movement is a non-government organization best known for its volunteers who have planted an estimated 51 million trees throughout Kenya to reduce the impact of climate change and preserve and restore ecosystems. Rapid population growth has been directly linked to diverse forms of environmental degradation and depletion of natural resources. Accordingly, in a special report for International Perspectives on Sexual and Reproductive Health, we presented our results on the feasibility, acceptability, and perceived value of Green Belt Movement volunteers also incorporating family planning promotion into their community development activities.
An Effective Messaging Strategy
The approach employed falls into the category of integrated development known as population, health, and environment, or PHE, whereby a single intervention combines components on the environment, community health, and family planning to achieve mutually beneficial goals. We found environmental agents can play an important role in disseminating family planning information, even without being trained as community health workers who provide methods.
The volunteers used a flipbook to conduct community education about the health, economic, and environmental benefits achieved through well-timed, well-spaced pregnancies, and worked in close collaboration with the governmental health sector to refer women and men to seek further counseling and methods at health facilities.
Our evaluation revealed that the volunteers conducted these activities effectively. A survey conducted at the end of the intervention found 80 percent of the trained volunteers had retained essential job knowledge about PHE and family planning. Green Belt Movement supervisors, who observed nearly 50 community meetings, found the volunteers prepared well for meetings (98 percent of observed meetings), used the flipbooks (87 percent), had effective presentation skills (94 percent) and provided clear and simple answers to questions (96 percent).
The evaluation included 16 focus group discussions with community members where volunteers were supposed to conduct PHE education. Participants in every group spoke favorably about the way volunteers conducted education sessions on the connections between family planning, healthy timing and spacing of pregnancies, and the environment. Further, participants reported sharing with others the family planning information they had received from volunteers in all 16 groups. In all but one group, participants personally knew someone who had sought family planning services after hearing PHE talks.