“… the way we welcome them is how we will lead them to love family planning.”: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

Schwandt, Hilary; Boulware, Angel; Corey, Julia; Herrera, Ana María Trejos; Hudler, Ethan; Imbabazi, Claudette; King, Ilia; Linus, Jessica; Manzi, Innocent; Merritt, Madelyn; Mezier, Lyn; Miller, Abigail; Morris, Haley; Musemakweli, Dieudonne; Musekura, Uwase; Mutuyimana, Divine; Ntakarutimana, Chimene; Patel, Nirali; Scanteianu, Adriana; Shemeza, Biganette-Evidente; Sterling-Donaldson, Gi’anna; Umutoni, Chantal; Uwera, Lyse; Zeiler, Madeleine; Feinberg, Seth

doi:10.1186/s12913-021-06282-x

Cited by 6 publications

(8 citation statements)

References 29 publications

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“…These studies, and our data, raise the question of whether CHV programs exploit the volunteer labor of people living in poverty, disproportionately women, to make the health system function [ 38 , 39 ]. However, the unfair burdens of volunteerism exist alongside evidence, from our study and others, that CHVs perceive great value from their community service [ 31 , 35 , 41 – 43 ], and express willingness to volunteer under financial strain while perceived or potential benefits outweigh the harms [ 38 , 41 ].…”

Section: Discussionmentioning

confidence: 89%

“…As in numerous other studies, we found that volunteer work imposed profound financial and time burdens on CHVs [ 23 , 31 , 38 , 39 ], which were exacerbated by also delivering free UPT. A growing body of literature on the experiences of CHVs has raised serious concerns about volunteerism, suggesting that volunteer duties may worsen CHVs’ pre-existing poverty [ 38 ], and contribute to overwhelming work and financial insecurity [ 23 , 31 , 40 – 43 ]. These studies, and our data, raise the question of whether CHV programs exploit the volunteer labor of people living in poverty, disproportionately women, to make the health system function [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

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Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis

Kibel

Thorne²,

Kerich³

et al. 2022

BMC Pregnancy Childbirth

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Background The majority of women living in rural Kenya access antenatal care (ANC) late in pregnancy, and approximately 20% have an unmet need for family planning (FP). This study aimed to determine whether training community health volunteers (CHVs) to deliver urine pregnancy testing (UPT), post-test counselling, and referral to care was an acceptable and feasible intervention to support timely initiation of ANC and uptake of FP. Methods We applied community-based participatory methods to design and implement the pilot intervention between July 2018 and May 2019. We conducted qualitative content analysis of 12 pre-intervention focus group discussions (FGDs) with women, men, and CHVs, and of 4 post-intervention FGDs with CHVs, each with 7–9 participants per FGD group. Using a pragmatic approach, we conducted inductive line-by-line coding to generate themes and subthemes describing factors that positively or negatively contributed to the intervention’s acceptability and feasibility, in terms of participants’ views and the intervention aims. Results We found that CHV-delivered point of care UPT, post-test counselling, and referral to care was an acceptable and feasible intervention to increase uptake of ANC, FP, and other reproductive healthcare services. Factors that contributed to acceptability were: (1) CHV-delivery made UPT more accessible; (2) UPT and counselling supported women and men to build knowledge and make informed choices, although not necessarily for women with unwanted pregnancies interested in abortion; (3) CHVs were generally trusted to provide counselling, and alternative counselling providers were available according to participant preference. A factor that enhanced the feasibility of CHV delivering UPT and counselling was CHV's access to appropriate supplies (e.g. carrying bags). However, factors that detracted from the feasibility of women actually accessing referral services after UPT and counselling included (1) downstream barriers like cost of travel, and (2) some male community members’ negative attitudes toward FP. Finally, improved financial, educational, and professional supports for CHVs would be needed to make the intervention acceptable and feasible in the long-term. Conclusion Training CHVs in rural western Kenya to deliver UPT, post-test counselling, and referral to care was acceptable and feasible to men, women, and CHVs in this context, and may promote early initiation of ANC and uptake of FP. Additional qualitative work is needed to explore implementation challenges, including issues related to unwanted pregnancies and abortion, the financial burden of volunteerism on CHVs, and educational and professional supports for CHVs.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis

Kibel

Thorne²,

Kerich³

et al. 2022

BMC Pregnancy Childbirth

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“…At the interpersonal level, providers share accurate information, clarify misguided rumors, and help clients find a method that will work well for them. This is especially important to sustaining contraceptive use among dissatisfied users, as continued counselling helps to prevent discontinuation [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, community visits from government representatives explaining the benefits of family planning may be particularly useful in areas where modern contraceptive prevalence remains low. Further investment in human resources such as nurses and CHWs would also be valuable, to improve accessibility and ensure that every household is reached [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms

et al. 2022

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Between 2005 and 2020, total contraceptive use among married women in Rwanda increased from 17% to 64%. The aim of this study is to better understand how the Rwandan government’s mobilization and demand generation efforts have impacted community norms and interpersonal discourse surrounding family planning. Eight focus group discussions with family planning providers and 32 in-depth interviews with experienced modern contraceptive users were conducted in 2018 in the two Rwandan districts with the highest and the lowest contraceptive prevalence rates. Results suggest that outspoken government support, mass media, and community meetings were valuable sources of information about family planning. Information received through these channels generated interpersonal dialogue about contraceptives through both conversation and observation; however, rumors and misinformation remained a significant barrier to use. A once taboo subject is now normative among married couples. Continuing to address common fears and misinformation through communication channels such as mass media and community meetings may help to further increase contraceptive uptake in Rwanda.

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“…Rwanda's family planning program is widely recognized as successful (17)(18)(19)(20)(21)(22)(23)(24)(25). In Rwanda in 2020, 58% of married women used modern contraceptives.…”

Section: Introductionmentioning

confidence: 99%

“She is courageous because she does not care what people think about her…”: Attitudes Toward Adolescent Contraception Use among Rwandan Family Planning Providers and Experienced Adult Female Contraceptive Users

Schwandt

Boulware

Corey

et al. 2022

Preprint

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Introduction: In Rwanda, only 20% of sexually active unmarried youth use contraception as compared to 64% of married women. Adolescence is an important time of growth and development that often includes the initiation of sexual activity. Sexually active adolescents need support in accessing contraceptive services to prevent negative health outcomes. In sub-Saharan Africa, the adolescent population represents a large share of the total population and that proportion is predicted to expand over time. Adolescent contraceptive needs have largely been unmet, and with growing numbers, there is increased potential for more negative health sequelae. Due to the low use of contraception by adolescents in Rwanda, and the growing population of adolescents, this study aims to explore the perspectives of family planning providers and adult contraceptive users on adolescent contraceptive use. Inclusion of adult community members in the study is a unique contribution, as research on adolescent contraceptive use in sub-Saharan Africa relies primarily on perspectives from adolescent and family planning providers.Methods: This qualitative study in 2018 utilized 32 in-depth interviews with experienced users of modern contraceptive methods and eight focus group discussions with family planning providers. Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively. Thematic content analysis was conducted in Atlas.ti. Results: Stigma regarding premarital sex results in barriers to adolescent access to contraceptive services. Family planning providers do provide services to adolescents; however, they often recommend secondary abstinence, offer a limited method selection, and accentuate risks associated with sexual activity and contraceptive use. Providers do support adolescent clients by emphasizing the need for privacy, confidentiality, and expedient services, particularly through youth corners, which are spaces within health facilities designed to meet youth needs specifically. Contraceptive using adult female community members advocate for youth access to contraception, however mothers are mixed in their comfort with discussing sexual health with their own youth. Conclusion: To destigmatize premarital sexual activity, government efforts to initiate communication about this topic must occur at national and community levels with the goal of continued conversation within the family. The government should also train family planning providers and all health personnel interacting with youth on adolescent-friendly health services. Dialogue between community members and family planning providers about adolescent access to contraceptive services could also reduce barriers for adolescents due to community members' generally supportive views on adolescent contraceptive use. Efforts to engage adolescent caregivers in how to talk with youth about sex could also contribute to expanded use.

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“… the way we welcome them is how we will lead them to love family planning.”: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

Cited by 6 publications

References 29 publications

Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis

Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis

Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms

“She is courageous because she does not care what people think about her…”: Attitudes Toward Adolescent Contraception Use among Rwandan Family Planning Providers and Experienced Adult Female Contraceptive Users

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