Effects of an Integrated Family Health Program International Conference on Family Planning: Research & Best Practices Ministry of Health, Ministry of Information/SIS IEC Center, Johns Hopkins University/ HCP & USAID/EGYPT
Outline of Presentation 1. Goals 2. Life Cycle Strategy t 3. Communication Interventions 4. Results: National and Community 5. Conclusions
COMMUNICATION FOR HEALTHY LIVING (CHL) 2004-2011 2011 Goals Improve health in the areas of: Family Planning/ RH Maternal and Child Health Infectious Disease (AI, Viral-Hep., Inf.Control) Other: Breast Cancer, FGC, Anti-smoking, diet, etc. Increase sustainability of Health Communication Increase sustainability of Health Communication programs in the public, private and NGO sectors
Life-stage Approach Young Married Older Men, Women Birth spacing, Safe Motherhood Nutrition Nutrition STIs High fertility Healthy Lifestyles Unmarried Youth (15-24) Nutrition/Performance Smoking cessation Healthy Lifestyles HIV/AIDS HOUSEHOLD AS PRODUCER OF HEALTH School Age (6-14) Nutrition FGC Healthy Lifestyles Early Childhood (<6yrs) 14 Immunization yrs status 49 Nutrition yrs ARI, CDD
Young Family Cohort Post-partum & FP Initiation FP & Birth Spacing Medically- assisted Delivery Reproductive Life Cycle Antenatal Care Newlywed
STRATEGY: MABROUK CONGRATULATIONS INITIATIVE Situation: Youth population size (> 40% of the population) Almost 800,000 marriages; 1,700,000 deliveries per year in Egypt Key entry point for FP/MCH messages Healthy beginnings yield long-term healthy practices Positive repositioning of family planning, family health Audience: Young couples and families (<30yrs) Communication Objectives: Improve Newlywed, ANC, Delivery, PP, and Family Planning Initiation & Spacing Practices
National Program Partners & Delivery Systems Ministry of Information Mass media plus 64 LICs Ministry of Health & Population 5000 PHCs 17,000 MOH Raedat Riffayet Private Sector ~30,000 Private Pharmacies Private Hospitals Media & Workplace partners NGOs/CDAs Save the Children as a main Partner ~ 150 NGOs/CDAs (CHL, Takamol) Caritas, CEOSS, and Red Crescent, Scouts
Communication Highlights TV / Radio/ Press Signature Message, Your Health is Your Wealth TV Spots air at avg. 66% Reach (FY 08) TV radio programs, edutainment Press popular magazines/news National Outreach Community Health Educators Publicity Events, Celebrities, theatre Workshops for media, religious and community leaders P&G Hospital program (10% deliveries) Service Support Pre-marital, Postpartum Protocols Counseling Materials
National Set of Materials Produced by SIS & MOH Message Consistency National Distribution system Consumer & Provider Materials
Results: Sources of data EDHS 2000, 2005, 2008 (national, sub-national comparisons) Egypt Health Communication Survey (EHCS) 2005, 2006, 2008 (national) Sales & Monitoring PARC, IMS, Sales, Omnibus Surveys (national) Village Health Survey (VHS) 2004, 2005, 2008 (intervention areas) Focal village M&E 2004 onward (intervention ention areas)
National Level Indicators
MORE WOMEN ARE HAVING 4+ ANTENATAL VISITS Perce entage 100.0 90.0 80.0 70.0 60.00 50.0 40.0 30.0 20.00 10.0 0.0 Percentage of women in Young Family Cohort By number of ANC visits for most recent birth, Among married women <30 years old with a birth in last 5 years 56.4 30.3 41.4 41.4 63.0 25.4 23.2 17.2 13.4 11.6 7.5 69.3 1995 (n=4,196) 2000 (n=4,234) 2005 (n=5,480) 2008 (n=4,619) Sources: EDHS 1995, 2000, 2005, 2008 None 1-3 4+
MORE WOMEN ARE HAVING MEDICALLY ASSISTED DELIVERIES Percent tage 90.0 80.0 70.0 60.00 50.0 40.0 30.0 20.0 10.0 Percentage of women in Young Family Cohorts By type of delivery assistance at most recent birth Among married women <30 years old with a birth in last 5 years 40.0 47.7 56.7 32.8 70.3 22.22 75.4 8.2 7.6 5.6 4.5 19.1 0.0 1995 (n=4,200) 2000 (n=4,235) 2005 (n=5,456 ) 2008 (n=4,617 ) Doctor Trained nurse/midwife Daya Relative/other No one Sources: EDHS 1995, 2000, 2005, 2008
MORE WOMEN IN YOUNG FAMILIES ARE INITIATING FP AFTER BIRTH OF FIRST CHILD Sources: EDHS 1995, 2000, 2005, 2008
Timing of Use after Delivery (Among Users) Source:EDHS 1995, 2000, 2005, 2008
Trend: INCREASE IN EVER USE YOUNG FAMILY COHORT WITH BIRTH IN PAST 5 YEARS Source:EDHS 1995, 2000, 2008
MORE WOMEN HAVING BIRTH INTERVALS OF 33 months or more (Young Family Cohort) Percen ntage 60.0 50.0 40.00 30.0 20.0 30.7 Percentage of women in Young Family Cohorts by birth interval for most recent two births Among married women <30 years old with a birth in last 5 years 39.1 42.4 30.3 28.4 28.0 29.1 26.2 45.8 23.2 26.4 50.5 10.0 0.0 1995 (n=3,052) 2000 (n=2,898) 2005 (n=3,649) 2008 (n=3,033) <24 months 24-32 months 33+ months Sources: EDHS 1995, 2000, 2005, 2008
NGO/CDA Sector: CHL Community Health Program Program Coverage 206 Villages in three Governorates 113 Health Units 1,000,000 Est. Population Program Structure CDA, Village Health Committee / Board Leadership: Dawar & AWSO Family Health Package
Community Level Indicators
Antenatal Care 100 75 50 48 68 77 62.5 85.9 33.1 31 2004 2005 2007 25 22 19 0 Any ANC 4 visits it & More % of Anemia Source of Data: M&E System
Safe Delivery % Medically-assisted births by Physician or Nurse 90 80 79.4 70 60 50 40 30 20 10 60.2 66.4 0 2005 2006 2007 Source: M&E Sysytem
Spacing Interval among women delivered 1.5 years ago 100 90 80 70 60 50 40 30 20 10 0 1.1 <24 months 24 months-33 months 4.3 3.8 90.8 >33 months Never pregnant since last birth Source: Monitoring System
Postpartum care & Family Planning Percentage of family planning practice within 2 months of delivery among women having postpartum visits 86 85 84 83 82 81 80 79 78 77 76 85.1 84.4 79.5 2005 2006 2007 Source: Monitoring system
Conclusions There are gateway effects for MCH behaviors on FP use: Health practices at one stage predict health practices at the next, creating a virtuous cycle for good health Communication influence these effects? The norm thus created have a positive The norm, thus created, have a positive effect on the practice in the population over time
Synergistic effect of early behavior change Increased likelihood of low parity FP use in 2008 as a function of early family lifestage behaviors (practices around first birth) All currently married women Practices around Birth of 1 st child UNIVARIATE ANALYSIS OR n p 4+ ANC visits 1.21 3425.037 Medically assisted delivery 1.40 3442.002 Child received PPC care within 2 months 1.14 3392.102 Mother received PPC within 2 months 131 1.31 3446.002 Six month exclusive breastfeeding Any exposure to FP messages 2.20 3078.0001 1.20-1.22 -.018-.030 Source: EDHS 2008 (n=3446 CMWRA)
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