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Kampala Conversations: Knowledge to Action for Family Planning

April 12-23, 2010
http://my.ibpinitiative.org/kampalaconversations 

This two-week forum focused on “increasing family planning (FP) services to improve international FP programs,” a major theme that was expressed in many of the presentations and discussions at the International Family Planning Conference held in Kampala, Uganda, November, 2009.

Discussion Statistics


Number of participants: 688
Number of participants' countries: 69
Number of contributions: 74 contributions
% of contributions from developing countries: 34%
Number of countries contributing: 14 countries

Contributing countries: Pakistan, Uganda, Kenya, Iran, Democratic Republic of Congo, Ghana, Nigeria, Mali, Nepal, USA, India, Ethiopia, Sudan, other African countries


Purpose and Objectives

Purpose:

This two-week forum focused on “increasing family planning (FP) services to improve international FP programs,” a major theme that was expressed in many of the presentations and discussions at the International Family Planning Conference in Kampala, Uganda, November, 2009.                                                                           

Objective:

To discuss the importance of:
  • Promoting the national FP policy environment and commitment
  • Recognizing FP as an essential link to achieving the Millennium Development Goals (MDGs)
  • Increasing access to the latest contraceptive technologies
  • Increasing access and demand for FP services                                                                

Day 1:  Increasing family planning (FP) services to improve international FP programs 

Questions:

  1. Thinking about the four objectives of this forum, has your organization implemented (or do you plan to implement) any new activities based on findings presented or discussions that took place during the International Conference on Family Planning?                                                                             

Day 1 Summary:

Answers to the Day 1 question reflect incredible engagement, commitment and concern among the participants that all pregnancies be wanted and that all families and individuals have access to high quality information and services to decide when and how many children to have. Hearing about the challenges many participants face in bringing good family planning services to communities shows we still have a long way to go in terms of good contraceptive counseling, so women do not fear losing their ability to bear children and understand enough about contraceptive methods to make informed choices. That distance is also encumbered by ensuring commodity distribution systems work and do not fail the clients who rely on them for regular supply, that providers do not introduce their own biases and preferred methods when serving clients, that both partners (male and female) can be equally involved in, and supported by their communities, in their contraceptive decisions, and that reproductive and health needs are fully met from the pre-conception through post-partum stages.

Day 2: Key steps for promoting the national FP policy environment and commitment 

Questions:

  1. What potential is out there that shows models of good public private partnership in delivering family planning?
  2. What incentives could help governments that are not yet on board to intensify their focus on family planning?


Day 2 Summary:

Contributors sought the advice of guest expert, Dr. Kanyoro, about how to include family planning programs in a conflict burdened environment, especially when the very notion of family planning is controversial. Others wondered why donors avoid working with local and regional organizations. A number of contributors raised the need for community-based distribution of a variety of contraceptive options as well as access to accurate information at all levels. Dr. Kanyoro stressed the ability of individuals to play an important role in influencing the policy arena while encouraging public-private partnerships to create a more open environment for promoting family planning.

Day 3: Recognizing FP as an essential link to achieving Millennium Development Goals (MDGs)

Questions:

  1. What examples can you share from your country’s experience with FP programming that demonstrate linkages between any or all of the MDGs?
  2. Are any of the specific MDGs (apart from MDG5) of greater importance to how your country envisions the linkage to FP choices and programs?

Day 3 Summary:

Participants provided examples of how countries are using the delivery of family planning to achieve multiple MDGs. One participant from Uganda raised the important issue of ensuring that family planning programs meet the needs of persons with disabilities.
Other participants from Nigeria discussed the importance of political commitment for family planning. It is not enough if only individual organizations recognize the link between FP and achieving the MGDs. It is also necessary that governments recognize and support this link if countries are to achieve the MDGs by 2015. 

Day 4: New contraceptive technologies

Questions:

  1. How important do you think it is to develop improved and new contraceptive technologies compared with expanding access to and availability of current technology?
  2. What do you see as priorities for new contraceptive technologies, both adaptive technologies and totally new technologies, that you think are needed in your program?
  3. What other technologies do you think would have impact if they could be developed?

Day 4 Summary:

Several respondents suggested that we need to expand access to currently available contraceptive methods and improve these methods to make them easier to use, easier to deliver, provide them less expensively and to make them more acceptable. A range of safe and effective methods are needed to meet the changing needs of women, men and couples throughout the different stages in their lives. Unless certain barriers to access to modern methods are overcome, some people will not have access to new and better contraceptive technologies.

Other respondents opined that “cost” is a serious problem to greater accessibility of contraceptive technology, and that inadequate funding for family planning programs and the lack of Depo-Provera and long-acting methods in the community is a major constraint to use.

Many participants commented on new contraceptive methods including a “long-acting combined hormonal contraception,” an “effective pregnancy vaccine,” and an “improved morning after pill” that can be used as a regular method for preventing unintended pregnancies.” Several also posted messages about Norplant and female condoms.

Day 5: Increasing access and demand for FP services

Questions:

  1. How do you promote demand within the communities you are serving? Are you using mobile services? Are you actively engaging your community health workers, and are you mobilizing communities around family planning? 

Day 5 Summary:

We often face controversy in many countries when we start discussing family planning. However, focusing on health promotion and protection and help communities, even the most conservative, become interested and engaged. When communities understand and know about the benefits of pregnancy spacing, that knowledge can help a person make an informed choice about fertility. It takes a “multi-spectral” or multi-pronged” approach to promote demand and we cannot forget how important it is to engage men in this process.

We also cannot forget, “no product, no program,” We cannot have a good FP program if we do not have supplies. We need to partner with advocacy groups to approach governments, especially Ministries of Finance, Economy or Treasury, and explain that the purchase of contraceptives should be included as a protected item in national budgets. The evidence is there – family planning is the cheapest, easiest and fastest way to achieve MDGs 4 and 5.

Program Examples
Iran:  "Promoting national policy and commitment should be an active part for each living family planning activity, and it is visible in our country programs. We started promotion for commitment and national policy for other than population issues. Our experience in this regard extends more than five years, and we have done different activities according to this strategy. This strategy is based on health impacts of family planning programs, especially on mother and child health, family health and one very important issue: strengthening the family structure in the country. As we are aware, most of the governments putting big values on the family as an important core to the society. So we added this strategy and related activities to the program two years back. By improving family health indices, the welfare level will increase among the families, and family planning has an important role in this regard."  Mohammad Eslami

Jordan: "Another positive experience of increasing access and demand for FP services is the experience of over 150 physicians in private practice in Jordan. These physicians in private practice were asked to join a network whereby they would be eligible for training and assistance in providing quality RH services to their clients, access to certain supplies at a reduced cost, and having their practice branded to indicate to their clients that the participating physicians had met certain quality standards.

Key to the program was the development of standards in family planning, including attention to counseling women with certain conditions and characteristics (e.g. adolescence, menopause, breast cancer and STIs) and a self-assessment tool for use by the providers. The providers were instructed in the self-assessment of their practice that included both the "preparedness" of the clinic to provide quality services as well as ongoing assessment of their technical skills. Also included in the tool were dimensions concerning marketing of their services to clients in the community and helping the physicians with their business management skills, an important aspect for individuals in private practice."  Nagham AbuShaqra and Mary Segall

Nigeria:  Our experience in the Extending Service Delivery Project (ESD) with Religious Leaders in Northern Nigeria has been very rewarding because we have focused our intervention on healthy timing and spacing of pregnancies. Not only in Northern Nigeria have we faced controversy when we start discussing family planning. Our experience in the Extending Service Delivery Project (ESD) with Religious Leaders in Northern Nigeria has been very rewarding because we have focused our intervention on healthy timing and spacing of pregnancies. The same goes for work done by Pathfinder International (www.pathfind.org) in very conservative areas of Ethiopia, Egypt and Yemen and Management Sciences for Health (MSH; www.msh.org) in Afghanistan. We are finding out that in more conservative settings it is not culturally appropriate to start a dialogue by discussing family planning. However, when we work from a perspective of health promotion and protection, and we discuss with mothers the health benefits to of waiting 2 years to get pregnant after a delivery, or when we discuss that neonatal and child health improves when pregnancies have been spaced, then, everybody, even the most conservative groups, are immediately interested and engaged. Please visit our website, www.esdproj.org, and you will find a very useful training module on Engaging Muslim Religious Leaders in Family Planning as well as several tools that can help you include Healthy Timing and Spacing of Pregnancy (HTSP) messages in your programs. You can also refer to FHI’s materials on Muslim and Christian Religious Leaders (www.fhi.org) and the work that the Institute of Reproductive Health of the University of Georgetown does in fertility awareness methods and their work with international faith based organizations (www.irh.org). Milka Dinev

Post-forum survey results

N of surveys completed - 64

% who have passed content to others - 59%

% who have or will use in their work - 97%

% very satisfied with forum content - 75%

Suggestions for improvement:

  • Include some photos, pictures or diagrams etc 
  • Keep bringing guest [experts] but call for questions or topics from others on the 'floor.'                                                              

References and resources

Click here to see community library/list of references

Organizing groups

The Bill & Melinda Gates Institute of Population & Reproductive Health; David and Lucile Packard Foundation; World Health Organization/Department of Reproductive Health and Research; Family Health International (FHI); Office of Population and Reproductive Health, Bureau for Global Health, US Agency for International Development (USAID); Pathfinder International; Knowledge for Health Project, JHU/CCP)

Contributing experts/facilitators 

Dr. Amy Tsui, Director, The Bill & Melinda Gates Institute of Population & Reproductive Health; Professor in the Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health

Dr. Musimbi Kanyoro, Director of the Population Program at the David and Lucile Packard Foundation

Dr. Ward Cates, President of Research, FHI

Mr. Jeff Spieler, Senior Technical Advisor for Science and Technology, Office of Population and Reproductive Health, Bureau for Global Health, USAID

Ms. Milka Dinev, Project Director, Extending Service Delivery (ESD) Project, Pathfinder International

David Turok, MD, University of Utah

Steering committee

The Bill & Melinda Gates Institute of Population & Reproductive Health; David and Lucile Packard Foundation; World Health Organization/Department of Reproductive Health and Research; Family Health International (FHI); Office of Population and Reproductive Health, Bureau for Global Health, US Agency for International Development (USAID); Pathfinder International; Knowledge for Health Project, JHU/CCP

Moderators

Ashley Isabelle Spence, JHU/CCP