International Rescue Committee, Washington, DC, USA.
International Rescue Committee, New York, NY, USA.
Glob Health Sci Pract. 2018 Mar 30;6(1):161-177. doi: 10.9745/GHSP-D-17-00365. Print 2018 Mar 21.
Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month increased from 14 to 37 and the percentage of family planning adopters choosing LARCs increased from 50% to 66%. While implants continued to be the most dominant method, reaching 60% of the method mix in 2016, the percentage of clients adopting IUDs increased each year, from 3% in 2014 to 13% in 2016. In total, 39,399 clients started family planning methods during the post-program design change period (2014-2016). Our experience in eastern DRC demonstrates that women and their partners affected by conflict want family planning, and that it is feasible to deliver the full range of modern contraceptive methods when programs are adapted and sensitive to the local context.
刚果民主共和国东部受冲突影响地区的计划生育需求未得到满足,据报道高达 38%,而此类冲突环境中的妇女往往面临最大的产妇死亡风险。国际救援委员会在刚果民主共和国东部的 3 个省实施计划生育和堕胎后护理紧急方案,为妇女和夫妇提供计划生育服务,包括长效可逆避孕方法。本文介绍了 2011 年 6 月至 2013 年 12 月期间从 2 个卫生区获得的常规方案数据,以及 2013 年对计划生育客户以及男性和女性未使用者进行的定性评估结果。然后描述了如何根据这些发现调整方案,以改善计划生育服务的获取途径和客户知情选择,并评估方案设计变更对 2014 年 1 月至 2016 年 12 月期间常规方案数据的计划生育使用率和方法组合的影响。2011 年至 2013 年间,共有 8985 名客户采用了计划生育,每个设施每月平均有 14 名客户采用一种方法。在此期间,方法组合保持稳定,植入物占主导地位,达到 48%。定性研究中发现的采用障碍既有供应方面的,也有需求方面的,包括提供者、使用者和其他社区成员对某些现代避孕方法的误解。该方案根据评估结果实施了多项方案变更,包括临床辅导和支持性监督,以提高提供者的技能和态度,引入即时产后宫内节育器(IUD)和左炔诺孕酮释放宫内节育系统(LNG-IUS)的插入,以及开展行为改变沟通运动,提高对计划生育的认识。这些方案变更后,每个设施、每月采用现代计划生育的平均客户数量从 14 人增加到 37 人,选择长效可逆避孕方法的计划生育采用者比例从 50%增加到 66%。虽然植入物仍然是最主要的方法,占 2016 年方法组合的 60%,但每年采用宫内节育器的客户比例都有所增加,从 2014 年的 3%增加到 2016 年的 13%。在方案设计变更后的时期(2014-2016 年),共有 39399 名客户开始采用计划生育方法。我们在刚果民主共和国东部的经验表明,受冲突影响的妇女及其伴侣希望获得计划生育服务,并且在方案适应和对当地情况敏感的情况下,提供全套现代避孕方法是可行的。