FHI through PROGRESS is working with the Ministry of Health in Rwanda in a number of research studies and research utilization activities. The major projects address:
Reasons for Non-Use of Contraception
To understand factors constraining contraceptive use in Rwanda, the Ministry of Health collaborated with FHI to examine barriers to modern contraception and explore psychosocial factors influencing modern contraceptive use. The findings suggest that women would benefit from more accurate messages about risk of pregnancy, particularly in the postpartum period, and that information about IUCDs and sterilization could be improved. Also, the study found that men play a key role in a woman's decision to use contraception and that information supporting family planning needs to reach men. Results were disseminated to a variety of stakeholders at a national meeting in Kigali in October 2010 and are currently being disseminated to target audiences, including the religious community, journalists, and parliamentarians, in conjunction with IntraHealth. More information on the methodology, findings, and conclusions are
available here (PDF, 396 KB).
FHI is supporting the Rwandan MOH to increase access to quality vasectomy services in Rwanda by training physicians across the country to use a method of no-scalpel vasectomy known as cautery with fascial interposition and by building local capacity to use monitoring and evaluation for continuous quality improvement. Research suggests that this method of vasectomy results in lower pregnancy rates than other techniques at minimal cost. In September 2010, building on an earlier successful training, representatives from the MOH and the FP Technical Working Group developed a national scale-up plan. The numbers of vasectomy clients increased 250% in one year after the introduction of the new approach, from 219 in 2009 to 779 in 2010. In December 2010, 12 physicians and 18 nurses were trained in the Northern Province, and in the first six months of 2011, provider trainings will continue throughout the rest of country. Data from post-training evaluations, routine supervision visits, client follow-up, and interviews with providers will help guide the further scaling up this service and provide information relevant to global audiences. A summary of the project is available
here (PDF, 348 KB).
FHI is conducting programmatic research with the Rwandan MOH and Jhpiego to produce experience-based guidance regarding the feasibility of offering post-delivery IUCD insertion services in selected hospitals and health centers in Rwanda, as part of enhanced postpartum family planning (PPFP) promotion to all ANC and maternity clients. Phase 1of the study, begun in May 2010, involved training 12 maternity providers at Muhima Hospital (the country's highest volume maternity hospital), located in Kigali, to counsel women on PPFP and to insert IUCDs immediately post partum (within 48 hours of delivery). Additionally, providers in three health facilities referring antenatal care (ANC) clients to Muhima for delivery were trained on enhanced counseling to encourage use of postpartum family planning. In September, some 40 stakeholders met to discuss how best to expand PPFP counseling and PPIUCD provision within Rwanda. Implementation strengths and challenges from the pilot period were assessed and addressed and concrete recommendations were made for how to adapt the intervention before expanding to an additional four hospitals and eight health centers across the country. New trainings at Muhima Hospital included staff from district hospitals. The intervention places particular attention on reaching couples during ANC with comprehensive PPFP counseling and maintaining maternity providers' confidence and competence to offer PPIUCD insertion services. FHI will continue to collaborate with the MOH in monitoring service expansion.
Integrating Family Planning with Child Immunization Services
This study addresses a possible intervention to help address the high unmet need for family planning among women during the extended postpartum period. The study trained immunization providers to provide women bringing their new child for immunization shots to understand when they might be at risk of an unintended pregnancy and to refer them to a family planning provider. Baseline data collection (March-June 2010) included 795 women more than six months postpartum who were attending vaccination services and 63 immunization and FP providers. . These data will be analyzed in comparison to the follow-up data, which will be collected in June 2011. The intervention is part of a growing global interest in the potential for integrating family planning and child immunization services. PROGRESS has developed
background information on this topic, including an interactive map of projects around the world working on this approach.
Expanding Community-Based Family Planning Services
FHI supports the functioning of the FP Technical Working Group, which is led by the Ministry of Health. A project of the MOH of particular importance is the process of developing a national strategy and scale up plan for community based distribution of contraceptives, which is being initiated in three districts. In March and April 2010, 78 people were trained as trainers in community-based family planning. In July 2010, 3,068 community health workers (CHWs) were trained in community-based distribution of family planning services; about two-thirds of them were certified to provide injectable contraceptives. In the first month of service provision (November-December), 3,623 clients were served with a contraceptive method in the three districts; of these, 41% received injectables, 32% received condoms, 25% received oral contraceptive pills, and 2% received Standard Days Method. FHI continues to work with the MOH to monitor the progress of the program.
