The presentation addresses the importance of helping communities to reconcile the right of women to prevent unintended pregnancies and the inherent belief that practicing modern contraception is morally wrong. The Child Survival project in Burundi, which integrated birth spacing intervention clearly demonstrates women can be empowered to make decisions about their pregnancies.

1. BIRTH SPACING: WHAT CAN WE LEARN
FROM THE WOMEN OF BURUNDI ?
Integrating Family Planning in a Child Survival project
Dr. Paul Robinson, MBBS, MTS, MPH
Director, Health and Social Development Team
World Relief
CCIH Annual Conference, Arlington, VA June 8, 2013

2. OBJECTIVE:
DISCUSS METHODS AND RESULTS OF
INTEGRATING BIRTH SPACING INTERVENTIONS
IN A CHILD SURVIVAL PROJECT
Outline:
• Background & need for birth spacing
• Integration of Family Planning in a Child Survival Project
• Achievements of FP intervention
• Lessons Learned

3. 198,516
people
served in
Kibuye
Health Dist
of Gitega
Province
Network of
2,991
community
volunteers &
170 CHWs

4. REPRODUCTIVE HEALTH NEEDS
IN KIBUYE DISTRICT
6.4
22
8
16
0
5
10
15
20
25
TFR (Burundi) CPR (Burundi) CPR
(Kibuye/DHS)
CPR (Kibuye/CSP)
Percent

5. LOW UPTAKE OF CONTRACEPTIVES
LEADS TO HIGH MMR, IMR & GR
CPR
16%
contributes
to
MMR
499 /
100,000
LB
IMR
59 /
1000 LB
Population
Growth
Rate
2.4%

6. DOWNWARD SPIRAL OF
REPRODUCTIVE HEALTH
Religious & cultural
beliefs
Low literacy: 55%
Rumors &
misinformation Unmet need:
53%
High TFR, MMR, N/IMR

7. STRATEGIES FOR IMPROVING RH
OUTCOMES
CPR = 50.5% (42% modern methods)
Service
Delivery
by CHWs
FP
Promotion
by CGVs
Provincial
Workshop

8. PROVINCIAL WORKSHOP
Highlights
One day workshop coincided with MOH National RH Week
Opening by Governor of Gitega Province
Participants included 7 MPs, 29 church leaders, 21govt.
administrative leaders, 7 Ministry of PH officials and USAID
Country Representative
Outcomes = Recommendations
 Raising legal age of marriage
 Organizing campaigns for couples on limiting/spacing births
 Increasing collaborations between health administration and
churches to avoid contradicting messages on RH

9. FAMILY PLANNING PROMOTION BY
CARE GROUP VOLUNTEERS
 2,991 CGVs trained on FP messages and methods
 120 local community and church leaders trained on FP
 50 MOH staff in 11 health centers trained on FP messages,
methods and effective client counseling

10. FAMILY PLANNING PROMOTION BY
CARE GROUP VOLUNTEERS (CONTD)

11. SERVICE DELIVERY BY COMMUNITY
HEALTH WORKERS
 170 CHW have been trained on FP importance, methods and
dispelling rumors and false alarms
 Training also included Community Based Distribution of
contraceptives
 Additional 100 CGV leaders trained where CHWs did not
exist

12. Provincial
Workshop
Local
Workshop
Community
Health
Workers
+
Volunteers
THETHREE-PRONGEDAPPROACH

13. WOMEN WITH INCREASED AWARENESS AND
DEMAND FOR FAMILY PLANNING
 “We go to Kibuye and to Bukirasazi HC to get modern
methods where no one will identify us.”
 “Convince religious leaders because they present obstacles
to modern methods.”
 “Sensitize men to facilitate communication with their wives.”
 “It would be better if our husbands are involved in training
in order to hear the messages themselves, and not only be
informed by their wives.”
 Women from all communes confirmed that they know the CG
volunteers; they have been visited by the volunteers in the
last month and received from them FP messages. They know
the advantages of FP and modern methods available.

14. CHURCH LEADERS CHANGED THEIR VIEWS ON FP
 Curates (Parish Priests) of Catholic churches attended
provincial workshop at Gitega
 Church leaders attended district and local level meetings
following the provincial workshop
 Church leaders give FP messages to their congregations
 A Roman Catholic program teaches natural contraception
using Cycle Beads
 Religious and community leaders requested more training on
modern methods of FP and expressed interest in more
collaboration with the health system

15. REPRODUCTIVE HEALTH NEEDS
IN KIBUYE DISTRICT
6.4
22
8
16
0
5
10
15
20
25
TFR (Burundi) CPR (Burundi) CPR
(Kibuye/DHS)
CPR (Kibuye/CSP)
Percent

16. INCREASED CONTRACEPTIVE PREVALENCE
IN KIBUYE DISTRICT
6.4
18
8
16
42
0
5
10
15
20
25
30
35
40
45
TFR (Burundi) CPR (Burundi) CPR
(Kibuye/DHS)
CPR
(Kibuye/CSP)
CPR -- Final
KPC
(Kibuye/CSP)
Percent

17. INCREASED CONTRACEPTIVE
PREVALENCE IN KIBUYE DISTRICT
8
16
42
50
0
10
20
30
40
50
60
CPR
(Kibuye/DHS)
CPR
(Kibuye/CSP)
CPR -- Final
KPC
(Kibuye/CSP)
CPR -- Final
(All Methods)
Percent

18. LESSONS LEARNED
• Supply of contraceptives is essential as
awareness and demand are increased through
Social & Behavior Change interventions
• Performance-based financing scheme for
CHWs (paid by MOH) contributed to project
achievements
• Field staff & volunteers must know how to
address questions related to side effects of
contraceptives & rumors

19. LESSONS LEARNED (CONTD.)
• The church is a key factor for change in FP.
Church leaders should be trained on modern
methods of contraceptives
• Collaboration of volunteers, CHWs, community
leaders, church leaders & health committees
was essential for project success
• The Care Group Model is an effective
strategy for mobilizing communities through
reaching every household with FP messages &
services

20. CONTRIBUTIONS &
ACKNOWLEDGEMENT
• Melene Kabadege, MCH Regional
Technical Advisor, WR Burundi/ Rwanda
• Francois Niyitegeka, WR Burundi Program
Manager
• JJ Ivaska, Program Development & Accountability
Director, WR Burundi
• Olga Wollinka, WR HO MCH Specialist
• Victoria Graham, Sr. Technical Advisor, Bureau of
GH, USAID