Drs Steve and Margaret Brown with Marian Storkey.
Does your area have an effective and caring family planning programme, or are you considering how to improve or set up such a programme? Whatever the situation in your area, here are four key points to think about.
Some level of participation is essential if your programme is to be accepted and succeed. The level of participation may vary with each situation. Bear in mind that an efficient programme can be owned, managed and run by the people themselves. Get away from the idea that only “experts” can do this. Illiterate women can be taught to give Depo-Provera and to provide instructions in other methods. Local resident village health workers or family planning workers can give out supplies from their homes if necessary.
There needs to be understanding of the local, cultural and religious taboos and beliefs regarding fertility and family spacing. This means knowing what the local gossip is about and how the folk are thinking. Methods that women can use without the husband’s knowledge may be important in some areas.
Keep simple records to encourage good follow-up. Use the records to check and evaluate the success of the programme: e.g. What methods are actually being used? What are the reasons for stopping? Who are we serving – the rich or poor? Make sure that your approach is acceptable to the people with whom you are working.
People need to have good access to family planning help at times which are suitable for them. The best way may well be to encourage the people themselves to keep and manage stocks – especially in Muslim villages, where women are restricted. Mobile clinics may be appropriate in remote or inaccessible areas. Family planning clinics need to be open at hours which are suitable for the local community. People should not have to queue with sick patients to obtain family planning advice. The clinic should, if possible, be kept separate from health care or open at different times. People should be able to obtain supplies easily, without long delays. The atmosphere needs to be friendly and relaxed and staffed by people who can identify with the clients. Having a few, less educated, older women around is a good idea.
Regular supplies of contraceptives are very important. It may mean that you can only encourage one or two methods; but it is better to do two methods well, than to encourage various methods irregularly.
However, if it is possible to offer a wide range of methods, then couples can choose the one that suits them best. They are then much more likely to continue using this method effectively.
Ensure there is a good follow up of all couples.
This needs to be a major part of any programme. Target your educational messages to the specific groups of people who make the decisions about family planning – women; husbands; mothers-in-law; religious leaders. Keep to a few important points – such as breast-feeding for as long as possible. Make sure your messages answer the questions people are asking.
Emphasise the health of the mother and children and the spacing of families, rather than preventing children.
There needs to be education at the clinic as well. People need to understand about the method they will be using and any minor side-effects. Encourage staff to be caring and understanding so that people will feel free to ask any questions they may have.
Keep these four points – Participation, Acceptability, Availability, Education – at the centre of whatever programme you have and you will be able to encourage the development of healthy, happy families.
Drs Steve and Margaret Brown worked with Tear Fund in Bangladesh for twelve years.