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New Evidence on Vasectomy and Male Involvement in Family Planning in Rwanda

New Evidence on Vasectomy and Male Involvement in Family Planning in Rwanda. Joshua Davis, MSPH. Overview. Context and program background Data and Methods Research objective Methods Results Conclusions. Background – Rwanda. Population: 10,473,282 Pop. Growth: 2.7 (17 th Worldwide)

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New Evidence on Vasectomy and Male Involvement in Family Planning in Rwanda

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  1. New Evidence on Vasectomy and Male Involvement in Family Planning in Rwanda Joshua Davis, MSPH

  2. Overview • Context and program background • Data and Methods • Research objective • Methods • Results • Conclusions

  3. Background – Rwanda • Population: 10,473,282 • Pop. Growth: 2.7 (17th Worldwide) • TFR: 5.5 children/woman (22nd worldwide) • Most densely populated country in Africa (similar in density to Netherlands) • 48% of women want no more children • 38% of women have unmet need for FP (want to limit or space births but weren’t using contraception) • Government of Rwanda has made family planning a national priority

  4. Background – No-scalpel vasectomySafe, effective, underused

  5. Background – IntraHealth’s Pilot Program • Funding from USAID’s Office of Population • NSV initially introduced in two districts • Created supply of trained providers • Generated demand for services in population • Introduced data collection system for clients

  6. Data – Program Evaluation • Conducted in Summer of 2009 • Goal was to evaluate aspects of the pilot program that were successful and develop recommendations for a country-wide scale up

  7. Data – NSV client records • Parallel to standard HMIS to gather additional information on male acceptors • Additional questions were integrated into the patient screening form: • Demographic information on clients • Qualitative responses on use and attitudes towards family planning • Service outcomes and statistics

  8. Objective • To assess the profile of vasectomy acceptors and to identify key aspects of the program that led to relatively high uptake rates compared to similar efforts in Sub-Saharan Africa

  9. Methods – Program Evaluation • IntraHealth M&E staff conducted evaluation in Summer 2009 • Focus groups and individual interviews with 50 stakeholders • Process evaluation of pilot implementation

  10. Methods – Records Review • IntraHealth staff visited 10 sites where NSVs were preformed by project-trained staff • Records were entered into a database • Qualitative responses were categorized by in country staff

  11. Results

  12. NSV clients compared to DHS sample

  13. NSV clients compared to sample

  14. Reason for wishing to cease having children

  15. Reasons for choosing vasectomy

  16. Rumors heard about FP and vasectomy

  17. Previous contraceptive use

  18. Results – Program evaluation Sustainable Approach • 10 doctors and 25 nurses trained in NSV • Service expanded to 8 other (10 total) districts Community Health Worker outreach • 252 men (54%) reported speaking to a CHW before deciding to have a NSV Service Extension Model • 59% of NSVs were done as part of extension service Engagement of Political Stakeholders

  19. Conclusions • Given access and information, men in Rwanda are willing to accept sterilization as a from of family planning • Supply creation and demand generation need to be coordinated • IEC materials can be delivered at a community level in the absence of a mass media strategy

  20. Thank you

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