A comprehensive and integrated demand-side maternal health programme in Zambia achieved a 57% increase in the use of modern contraception over a two-year period. Modern contraceptive usage rates increased the most in Chama, a difficult to reach district in Muchinga Province. Despite the fact that communities in this district faced some of the most challenging physical access barriers, uptake almost doubled (from 18% to 35%).
The increase occurred in intervention sites supported by the Mobilizing Access to Maternal Health Services in Zambia (MAMaZ) Programme, implemented between 2010-2013 by Health Partners International (HPI), Transaid, Development Data and Disacare, in partnership with District Health Management Teams (DHMTs). The increase recorded in the programme’s intervention sites (from 21% to 33%) was higher than increases in control sites, at statistically significant levels.
MAMaZ was operational in six rural districts (Chama, Choma, Kaoma, Mkushi, Mongu, and Serenje), predominantly remote areas characterised by high levels of poverty. When the programme started, baseline studies showed that there were multiple barriers at both household and community levels that were delaying or preventing women from accessing essential maternal health services. These included lack of awareness, financial constraints, physical access barriers, and practical challenges such as lack of support for childcare. Despite efforts by the DHMTs to improve health service coverage by the provision of outreach services, rates of contraceptive uptake in these districts had been low and static for some time.
Working through trained community volunteers, MAMaZ and its district partners used a participatory discussion group methodology to mobilise communities around a safe motherhood agenda. Personal and communal reflection on the maternal health situation took place in groups as well as actions that could be taken to improve it. Innovative training approaches were used to raise awareness of the range of maternal, sexual and reproductive health services available at the local health facilities and why and when it was important to access them. Communication body tools, such as the “say and do” method where key messages were represented by a gesture or pose, helped participants remember the verbal message associated with the action, and proved very effective and popular with the communities. The image above shows the community in Serenje Central demonstrating the five finger method. The communities created songs and dances and used them to engage individuals who were not reached by the discussion groups.
To facilitate the transition from awareness to action, communities were supported to establish their own systems (community transport; child care schemes; food banks; savings schemes) that would allow them to use health services in a timely way. The involvement of men in discussion groups helped to increase their awareness of and support for women’s health issues, and male attendance at antenatal care sessions, where they were able to access information on family planning, increased considerably. The engagement of traditional leaders created an enabling environment for the community level change process and many of these leaders went on to become effective advocates for birth spacing and for women’s health generally. An endline survey towards the end of the programme found that social norms relating to maternal and newborn health had shifted considerably as a result of the programme.
MAMaZ demonstrated that it is possible to substantially increase family planning uptake by including a focus on birth spacing, and promoting the use of antenatal and postnatal care services, in an intervention that used safe motherhood as an entry point for engagement with communities. The MAMaZ experience shows that family planning mainstreaming approaches can be very effective in situations where communities perceive that their priority health issues are being adequately addressed.
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