Giving family planning a human face

A ‘loveless’ loveteam that clicks – and how!

As of August 2002, family planning was not openly discussed, and there was a prevalence of misconceptions on family planning methods. This situation was brought about by couples receiving incorrect information on family planning through various sources – neighbors, family and friends; health providers who had misconceptions about family planning methods, and media reporting that was infrequent and irregular and focused on population and development issues and data which couples could not relate to.

That year, with funding from USAID, the Academy for Educational Development (AED) launched The Social Acceptance Project (TSAP) to help the Philippine government respond to the lack of social acceptability of family planning. TSAP embarked on an integrated strategy to increase public approval of family planning and open discussion about family planning.

Today, four years later, couples now receive better and correct information on family planning. They may have attended chat sessions organized by a family planning champion. Community influentials talk openly about family planning, and some local government may have already allocated funds for commodities. The midwife at the health center now gives correct info, even using a flipchart or desk chart.

Indeed, as USAED chief of party Eleanora de Guzman said, "We have generated ripples of action that have now grown into waves of change."

How did TSAP do it? By three strategies.

First, Ms. De Guzman said at a program closing the project two months ago, influential individuals and groups who could champion family planning were identified – market and sidewalk vendors, tricycle and jeepney drivers and urban poor dwellers. They were given updated educational materials on family planning and taught how to speak convincingly about the subject in public.

Starting in 2005, seven alliances were formed out of those "champions." Sixty four organizations with three million members from 13 sectors are now publicly promoting family planning. With assistance from TSAP’s small grants program they were able to conduct 904 chat group sessions on all family planning methods, reaching 10,600 men and women with unmet need in pilot areas. Of these, 2,213 decided to voluntarily accept a method and were provided family planning services including the Natural Planning methods right after the sessions, while 4,400 were referred to health facilities for family planning services.

As a positive unintended result, said Ms. de Guzman, these organizations were able to influence local resolutions on family planning, generating a total of P2.8 million for the purchase of contraceptives and other family planning activities in municipalities and barangays.

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A second strategy was getting together obstetrician-gynecologists to develop research-based responses to common misconceptions about methods. The responses were packaged into Critically-Appraised Topics or CATS which were incorporated in training and educational materials distributed to public health providers. Trained were 926 midwives, 181 doctors and 399 nurses.

TSAP assisted the DOH in revising the Family Planning Clinical Standards Manual or the Green Book to incorporate updated and evidence-based information for health providers. This Manual was one of the deliverables USAED officially turned over to the health department, which has committed itself to pursuing what TSAP has successfully delivered.

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The third strategy was undertaking efforts "to increase positive reporting of family planning issues in the national and local media to give family planning a human face," said Ms. De Guzman.

TSAP encouraged media to actually see the benefits of family planning methods and observe the lives of family planning acceptors and non-acceptors. As a result the coverage of family planning news progressively increased, with emphasis on positive reporting.

Also significant was the effect of the TV, radio and print campaigns sponsored by nine large organization. The campaign slogan was Sa modern methods, sigurado ka, walang patsamba-tsamba.

Through two of the most popular TV spots – Gising or Wake Up and Oops – a post-campaign survey of 2004 revealed that 84 percent of people in metro areas and 61 percent of people in low contraceptive prevalence areas indicated they were aware of modern family planning methods; 90 percent strongly approved of family planning, and 30 percent endorsed family planning methods.

Still on media effectiveness, in late 2005 and early 2006, TSAP supported a region-specific radio campaign to clarify specific misconceptions on family planning methods like the pill, IUD, tubal ligation and no-scalpel vasectomy. The radio materials were developed by local partners, radio station managers and broadcasters and were aired in local radio stations.

Still another device used was a Family Planning Hotline which was accessible by text, phone or email. Under the sponsorship of DOH, the hotline was developed in light of couples’ reluctance to go to health providers. From August 16, 2004 to July 15, 2006, FamPlan Hotline received nearly 61,000 text queries or around 2,500 per month, mainly on family planning matters.

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A major reason for the low acceptance of family planning in the Autonomous Region of Muslim Mindanao or ARMM was the common perception that Islam was opposed to it. TSAP supported a group of ulamas in developing a national fatwa, or edict, that states that family planning or birth spacing is allowed by the Koran. The ulamas were sent to Egypt to get the endorsement of the fatwa of the Grand Mufti of Egypt.

On March 1, 2004, the Darul Ifta or House of Islamic Opinion proclaimed the national fatwa on family planning and reproductive health during an assembly of around 200 Muslim religious leaders in ARMM. TSAP also supported the training of ARMM-based health providers on evidence-based counseling and the development and airing of a radio campaign to disseminate information on the edict.

As a result of these efforts, 28 percent of the population of ARMM are now aware of the fatwa, 76 percent of Muslim religious leaders know about it, and 77 percent are actively supporting it.

Incidentally, USAED supported the Center for the Promotion of Peace and Development in Mindanao when it held a conference on the fatwa among Muslim leaders and NGOs at the UP in Diliman, Quezon City. This conference on the fatwa was the first held outside the ARMM region.

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Have the TSAP organizers achieved their objectives? Yes, we have, said Ms. De Guzman, judging from data showing that the proportion of the general public in metro areas who strongly approved of family planning practices has increased from 76 percent to 90 percent; the proportion of those endorsing family planning practice to others has increased from 18 percent to 30 percent, and those who say that they intend to practice family planning has increased from 60 percent to 65 percent.

At the TSAP turnover ceremonies, Jon Lindborg, mission director, USAID Philippines, and Ms. De Guzman turned over deliverables, including the Green Manual, and CDs of survey results and media promotional materials, to the Department of Health, represented by Usec Alex Padilla and Undersecretary Ethelyn Nieto. Present were Tom Osias, executive director, Population Commission; Dr. Aye Aye Thwin, chief, Office of Population, Health and Nutrition, USAID Philippines. Dr. Nieto received cheers when she said that DOH was continuing the program begun by USAED.

And the work continues, with favorite columnists and radio or TV broadcasters like Korina Sanchez, Angelo Palmones, Susan Enriquez and Ces Drilon relating compelling stories on family planning.

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My e-mail: [email protected]