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ORIGINAL ARTICLE
Open Access

Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo

Lara S Ho and Erin Wheeler
Global Health: Science and Practice March 2018, 6(1):161-177; https://doi.org/10.9745/GHSP-D-17-00365
Lara S Ho
aInternational Rescue Committee, Washington, DC, USA.
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  • For correspondence: lara.ho@rescue.org
Erin Wheeler
bInternational Rescue Committee, New York, NY, USA.
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  • FIGURE 1.
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    FIGURE 1.

    Project Timeline, Health Zones A and B in South Kivu, Democratic Republic of the Congo

    Abbreviation: LNG-IUS, levonorgestrel-releasing intrauterine system.

    a Includes 2 facilities from a different health zone in South Kivu than the other health facilities reported in this article.

  • FIGURE 2.
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    FIGURE 2.

    Number of Clients Adopting Family Planning Methods, Health Zones A and B in South Kivu, Democratic Republic of the Congo, June 2011 to December 2013

  • FIGURE 3.
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    FIGURE 3.

    Contraceptive Method Mix Among Clients Adopting Family Planning Methods, Health Zones A and B in South Kivu, Democratic Republic of the Congo, June 2011 to December 2013

    Abbreviations: OCP, oral contraceptive pill; IUD, intrauterine device.

  • FIGURE 4.
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    FIGURE 4.

    Salience Index Scores for Reasons People Might Accept Family Planning Cited by Male and Female Non-Users of Contraception

    Note: Salience index scores range from 0 to 1 and indicate the relative percentile rank of items within each topic area across the focus groups with male and female non-users.

    * Asterisked items indicate categories that were either not mentioned at all by the men's and/or women's focus groups or mentioned by at least one focus group but the salience scores approached zero. In this instance, inheritance, family problems, and lack of control over one's children were not mentioned by any of the women' focus groups, and infidelity was not mentioned by any of the men's focus groups.

  • FIGURE 5.
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    FIGURE 5.

    Salience Index Scores for Reasons People Might Not Adopt Family Planning Cited by Male and Female Non-Users of Contraception

    Note: Salience index scores range from 0 to 1 and indicate the relative percentile rank of items within each topic area across the focus groups with male and female non-users.

    * Asterisked items indicate categories that were either not mentioned at all by the men's and/or women's focus groups or mentioned by at least one focus group but the salience scores approached zero. In this instance, failure of a method, lack of money, and sexual pleasure were not mentioned by any of the women's focus groups, and in-laws was not mentioned by any of the men's focus groups.

  • FIGURE 6.
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    FIGURE 6.

    Salience Index Scores for Sources of Information About Family Planning According to Male and Female Non-Users of Contraception

    Abbreviation: CHW, community health worker.

    Note: Salience index scores range from 0 to 1 and indicate the relative percentile rank of items within each topic area across the focus groups with male and female non-users.

    * Asterisked items indicate categories that were either not mentioned at all by the men's and/or women's focus groups or mentioned by at least one focus group but the salience scores approached zero. In this instance, schools, over a drink/beverage, and partner were not mentioned by any of the women's focus groups.

  • FIGURE 7.
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    FIGURE 7.

    Salience Index Scores for Influential People in Making Decisions About Family Planning According to Male and Female Non-Users of Contraception

    Note: Salience index scores range from 0 to 1 and indicate the relative percentile rank of items within each topic area across the focus groups with male and female non-users.

    * Asterisked items indicate categories that were either not mentioned at all by the men's and/or women's focus groups or mentioned by at least one focus group but the salience scores approached zero. In this instance, school headmaster was not mentioned by any of the women's focus groups.

  • Figure
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    A Ministry of Public Health doctor demonstrates the postpartum IUD insertion technique to nurses and midwives in eastern DRC. © 2016/Mirindi Munyangura John/International Rescue Committee.

  • FIGURE 8.
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    FIGURE 8.

    Number of Clients Adopting Family Planning Methods, Health Zones A and B in South Kivu, Democratic Republic of the Congo, Post-Program Design Changes, January 2014 to December 2016

  • FIGURE 9.
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    FIGURE 9.

    Trends in Contraceptive Method Mix Among Clients Starting Family Planning Methods, Health Zones A and B in South Kivu, Democratic Republic of the Congo, 2014–2016

    Abbreviations: OCP, oral contraceptive pill; IUD, intrauterine device.

Tables

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    TABLE 1.

    Sampling of Health Facilities for Formative Research

    Health ZoneFacilityReason for selection
    A1Relatively high proportion of clients accepting IUDs
    2Relatively low proportion of clients accepting IUDs
    3High number of clients accepting contraceptive methods, relatively low proportion of clients accepting IUDs
    B4High number of clients accepting contraceptive methods, relatively high proportion of clients accepting IUDs
    5High number of clients accepting contraceptive methods, relatively low proportion of clients accepting IUDs
    6High number of clients accepting contraceptive methods, relatively low proportion of clients accepting IUDs
    • Abbreviation: IUD, intrauterine device.

    • View popup
    TABLE 2.

    Key Program Strategies Before and After the Formative Assessment (New Activities in Bold)

    2011–20132014–2016Formative Assessment Themes Addressed
    Supply-side activities
    • Competency-based clinical training

    • Provision of commodities and equipment

    • Supportive supervision

    • Support for data collection and use

    • Competency-based clinical training

    • Provision of supplies and equipment

    • Supportive supervision

    • Support for data collection and use

    • Systematic clinical coaching and tracking individual provider competence

    • Peer supervision by high-performing providers

    • Values clarification activities with providers

    • Introduction of LNG-IUS

    • Introduction of Population Council's Balanced Counseling Strategy

    • Quality of services

    • Side effects

    Demand-side activities
    • Large community meetings on the benefits and availability of family planning

    • Home visits by community health workers that include discussion of family planning

    • Large, multichannel SBCC campaigns on family planning

    • Community mobilization by satisfied users

    • Targeted outreach to male partners

    • Actively dispelling rumors about certain methods

    • Home visits by community health workers that include discussion of family planning

    • Lack of knowledge; misconceptions, rumors, misunderstanding; sources of information

    • Influential people in decision making

    • Abbreviations: SBCC, social and behavior change communication; LNG-IUS, levonorgestrel-releasing intrauterine system.

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Global Health: Science and Practice: 6 (1)
Global Health: Science and Practice
Vol. 6, No. 1
March 21, 2018
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Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo
Lara S Ho, Erin Wheeler
Global Health: Science and Practice Mar 2018, 6 (1) 161-177; DOI: 10.9745/GHSP-D-17-00365

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Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo
Lara S Ho, Erin Wheeler
Global Health: Science and Practice Mar 2018, 6 (1) 161-177; DOI: 10.9745/GHSP-D-17-00365
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    • Abstract
    • BACKGROUND
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    • RESULTS FROM THE 2013 INVESTIGATION
    • PROGRAM MODIFICATIONS
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