This poster was presented by Elia Fernandes and Antonia Mesquita at the International Conference on Family Planning (ICFP) in Kigali, Rwanda in November 2018. USAID’s Reinforce Basic Health Services Project, implemented by JSI Research & Training Institute, Inc. (JSI) addresses declining availability and use of modern family planning (FP) services. When the program began in 2016, a significant proportion of women were not well-informed about side effects or method options available to them. Myths and misconceptions about the benefits of FP, gender roles, religion, and cultural and other belief systems all affect demand for FP. Using a comprehensive social and behavior change approach at both the individual and facility level, community and system interventions were held. They developed five short films and held community discussion groups to improve knowledge of FP methods and their benefits. They also worked with communities to develop action plans to improve community access to FP services.

1. Timor-Leste
FILLING THE VOID: INCREASING THE USE
OF FAMILY PLANNING SERVICES
IN TIMOR-LESTE
AUTHORS: Elia Fernandes, Antonia Mesquita, Elizabeth Bunde, and Marianne Viatour—JSI Research & Training Institute, Inc.
BACKGROUND
USAID’s Reinforce Basic Health Services Project, implemented by JSI Re-
search & Training Institute, Inc. (JSI) addresses declining availability and
use of modern family planning (FP) services. When the program began in
2016, a significant proportion of women were not well-informed about
side effects or method options available to them.
CONCLUSIONS
To develop interventions and messaging to increase demand for and
use of FP methods:
• Identify messages that resonate with clients to showcase benefits
and minimize misconceptions.
• Increase exposure to FP information in community, rather than only
facility settings.
• Foster a “men-as-partners” culture for family planning to address
gender roles.
• Learn from the client perspective and experiences to make sure
they receive the information they need.
Community Interventions
1. Held community discussion groups for all men and women
of reproductive age in Covalima’s 147 communities (aldeias)
to improve knowledge of FP methods and their benefits.
2. Developed five two-minute films and printed materials
to share key FP messages.
System Interventions:
1. 72% of all the communities in the district have participated
in FP-focused community discussion groups.
2. Four villages have developed action plans to improve
community access to FP services, especially around innovative
transport options for couples seeking FP services.
RESULTS
• In the 27 months since interventions were implemented, more
than 350 FP-focused discussion groups were held, attended by
more than 4,000 women and more than 1,000 men.
• Of the 25 public health facilities in the district, all are staffed with
health providers certified to provide FP counseling and short-acting
methods. Among these, 17 are staffed with at least one health provid-
er certified to provide long-acting reversible contraceptive methods.
• There have also been marked improvements in FP use with an
almost two-fold increase in couple years of protection (CYPs).
The proportion of CYPs attributed to injectables has increased
three-fold, with pill CYPs increasing more than five-fold, and CYPs
attributable to implants increasing by 60%.
PROGRAM INTERVENTION
Using a socio-ecological perspective, JSI developed a
comprehensive social and behavior change (SBC) approach:
• Individual level behavior change:
community discussion groups and face-to-face interpersonal
outreach approaches with targeting messaging
• Facility level behavior change:
health workers’ skills in FP methods and counseling were
improved to increase access to FP methods and client/provider
interactions supported by SBC communication materials for client
and provider needs.
Demand
for Family
PlanningMyths and misconceptions about the benefits of FP,
gender roles, religion, and cultural and
other belief systems all affect demand for FP.
INDIVIDUAL LEVEL
BEHAVIOR CHANGE
FACILITY LEVEL
BEHAVIOR CHANGE
COMPREHENSIVE
SOCIAL & BEHAVIOR CHANGE (SBC) APPROACH
community discussion groups
and face-to-face interpersonal outreach
approaches with targeting messaging
health workers’ skills in FP
methods and counseling were improved
to increase access to FP
MORE THAN
350FP-FOCUSED
DISCUSSION
GROUPS
WERE HELD,
ATTENDED
BY...
72%OF ALL THE
COMMUNITIES
IN THE DISTRICT
PARTICIPATED
IN FP-FOCUSED
DISCUSSION
GROUPS.
...MORE THAN
4,000
WOMEN,AND MORE
THAN
1,000
MEN
OF THE 25
PUBLIC HEALTH
FACILITIES IN
THE DISTRICT
ALLARE STAFFED
WITH
FP-CERTIFIED
HEALTH
PROVIDERS
...AT A GLANCE
METHODOLOGY