Celebrate Solutions: Harnessing Peer Networks to Promote Family Planning

By: Claire Watt Rothschild and Shalmali Radha Karnad, Jacaranda Health

In June’s ‘Celebrate Solutions’ columns, Women Deliver is highlighting Jacaranda Health’s efforts to change the way family planning decision-making happens in the postpartum period among low-income women in Kenya.  As a maternity health care organization, Jacaranda Health works to make pregnancy and childbirth safer for women and newborns by building a new model of maternity care in East Africa; one that is respectful, high-quality and patient-centered.

“My friends told me that it’s still too early to start with family planning.” - Client, 9 weeks postpartum

“Everyone says that 3 months after delivery is the ideal time to start family planning.” - Client, 9 weeks postpartum

“I was told by my friend that family planning has negative effects on breast milk. So I’m not using any family planning yet.” - Client, 3 months postpartum

At Jacaranda Health, efforts to expand access to postpartum contraception have resulted in a rate of family planning that is more than three times higher than Kenya’s national average. Despite these successes, Jacaranda is still trying to understand why so many women do not adopt family planning at the recommended six weeks after childbirth. A key part of the human-centered program development is talking with clients – in focus groups, interviews, and informal chats – to understand their needs and build programs to address them. When postpartum clients were asked why they were not using family planning, the overwhelming response was that clients’ friends and family members told them six weeks was too early for family planning.

While peer networks can encourage the spread of misinformation and fears about contraception – as highlighted in the quotes above – peer-based communication can also be a powerful tool for promoting contraceptive uptake. In a study of male peer-based family planning education in Malawi (the Malawi Male Motivator intervention), investigators found the program significantly increased contraceptive uptake and promoted open discussion of family planning use within couples.

There is strong evidence that peer and family communications play a role in contraceptive uptake, method choice, and length of use – and can serve as either catalysts or barriers to accurate information and timely uptake of contraception among new mothers. Studies have found that women often put greater trust in information about contraception gained from peers and family members than from health professionals, and have also found that women often rely on personal experiences and anecdotes from peers about family planning use when making their own contraceptive decisions.

Recent interviews highlight the importance of peer networks in contraceptive uptake and choice of contraceptive type among Jacaranda clients living in peri-urban Nairobi. In a recent survey of Jacaranda clients obtaining a new contraceptive method, 89% said that they discuss family planning with their friends and family members and 69% reported obtaining the same method as a friend or peer. Furthermore, most women surveyed reported getting specific advice on which types of contraception to use, with 85% reporting that their peers had encouraged them to use a specific method and 88% reporting their peers had discouraged them from using specific methods.

Based on this evidence, Jacaranda is now working through peer networks to improve contraceptive access and information and to dispel rumors and misconceptions through the following approaches:

  • Developing a group model for antenatal service delivery with fully integrated family planning counseling

As mentioned in the post last week, Jacaranda is currently piloting a group-based antenatal program, with brings together antenatal clients with similar estimated dates of delivery for monthly group discussions and activities relating to pregnancy, delivery, and child and maternal care in the postpartum period. Family planning counseling is a core part of the curriculum, beginning from the first antenatal session. The group format allows for facilitated peer-to-peer conversations, with a nurse-midwife facilitator present to answer questions and correct misinformation when necessary. The support group continues into the postpartum period, with a group session timed to encourage contraceptive uptake at the recommended six weeks postpartum time point.

  • Encouraging peer networks to dispel contraceptive myths and misconceptions

Building off of our group antenatal program, Jacaranda plans to identify and develop peer ambassadors – “Mentor Mothers” – from among our group ANC participants. These Mentor Mothers will use a peer-to-peer approach to engage and educate other Jacaranda clients about family planning services at Jacaranda Health facilities.

Jacaranda is excited about the opportunity to build facility-community links using the power of peer networks to support and educate clients. They believe these networks provide a sustainable infrastructure for to exchange information, dispel myths, and empower clients to make knowledgeable decisions based on accurate information.

Keep watching for updates on Jacaranda’s peer-based family planning programs on our blog.

To read the rest of the Celebrate Solutions series on Jarcaranda Health please click here.

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