YOUTH AND FAMILY PLANNING INITIATIVE
HND 049 – AC 309
FAMILY PLANNING SOCIAL ANALYSIS
In 6 Municipalities of the La PazDepartment–Honduras
Duration: 8 months (1st. November 2008, to 30th June, 2009)
Responsible:Dacia Ramírez, Health Technical Advisor.
CARE Honduras.
Donor:CARE USA – Sexual and Reproductive Health Unit.
Contact:Luis Ortíz, Program Officer, RTHF
Sexual and Reproductive Health Unit - CARE USA
Tegucigalpa, Honduras
March 2009.
I N D E X
- CONTEXT OF FAMILY PLANNING IN HONDURAS------3
- INTRODUCTION ------4
- METHOD USED ------5
- FINDINGS ------7
A. Youth.
a)Family planning beliefs and knowledge of youth ------8
b)Importance of family planning according to youth ------8
c)Perception of youth on early pregnancy ------9
d)Access and quality of service of family planning for youth ------11
e)Demand and use of family planning methods by youth ------11
f)Family planning constraints in young population ------12
B. Volunteer Health Staff.
a)Sexual relations and early pregnancy ------14
b)Constraints that youth encounter in family planning ------15
c)Family planning services for youth ------17
- CONCLUSIONS ------17
- ANNEXES ------17
- CONTEXT OF FAMILY PLANNING IN HONDURAS.
Honduras IS ONE OF THE POOREST COUNTRIES OF Central America, maternal mortality is the fourth highest cause of death among women in reproductive age, and even though there is a tendency towards a decrease, this rate continues to be very high (280 for each 100,000 live births).
Data from the National Demographic and Health Census 2006-2007, shows that Honduras is one of the Central American countries that show the highest global fertility of the region with a rate of 4.4, this rate is even higher in the rural areas (5.6) than in the urban areas (3.3).
The range of age of women of reproductive age in Honduras is between 12 and 49 years; and this is due to the fact that 10.7% of women at 15 years of age have had at least one pregnancy, which are considered as of high risk.
Information on family planning has been widely distributed in Honduras, where 99.4% of Honduran women have knowledge on family planning methods; however, only 41% reported having used modern family planning methods and 9% having used traditional methods. The prevailing anti conceptive methods among Honduran women, whether or not they are married are sterilization (18.1%), oral contraceptives (9.9%) and IUD´s (8.5%).
According to data from the Epidemiologic and Family Health National Survey (ENESF 2001), half of the women between the ages of 20 and 24 years have given birth before they are 20 years old; this rate is higher among women with a lower level of education (70%), the poorer women (64%) and in rural areas (60%). Only one in three sexually active adolescent women use a modern contraceptive method, and in general the needs of 48% of adolescents have not been satisfied with an effective anti conception.
Even though adolescents are aware of modern contraceptive methods, they do not necessarily know where to obtain them, how to use them correctly and consistently and may not use them at all.
Therefore, it is vital for Honduras to reduce the high levels of adolescent pregnancies in order to improve women and their families’ lives, as well as that of society as a whole.
In response to this situation, the Health area of the government of Honduras, has proposed to reduce the rates of maternal and infant mortality rates significantly, for the period 2005 to 2010, through the implementation of a National Strategy, the objective of which is to avoid deaths stemming from obstetric and perinatal complications which are a result of high fertility and frequency of pregnancies.
The “National Strategy for the Reduction of Maternal and Infant Mortality”, designed by the Ministry of Health identifies Family Planning as the most important component in reducing maternal and infant mortality.
As part of compliance with this strategy, the government of Honduras has proposed the development of a “National Plan for the Assured Availability of Supplies and Contraceptives (DAIA)”. This includes actions in financial sustainability, purchasing, logistics (information, distribution, storage and delivery) and the political commitment to allow the supplies and contraceptive methods in the expected quantities, timeliness and quality.
This DAIA plan began in 2005 with a purchase process, with domestic funds, to gradually achieve purchasing 100% of needs by 2009, thus mitigating, the impact of the suspension of donations of contraceptive methods that the country had been receiving from USAID since 1999.
Supporting the Ministry of Health actions, ASHONPLAFA (Honduran Association of Family Planning) is the family planning NGO that assists almost a third of the contraceptive users in the whole country, both in their own clinical services as in those of the communities as well as through population social marketing.
- INTRODUCTIÓN.
CARE Honduras was one of the 6 countries[1] selected by the CARE USA Sexual and Reproductive Health Unit to implement “Youth and Family Planning”, as part of the Social Change and Knowledge Sharing initiatives.
An innovative element of the selected initiatives was use of a “Social Action Analysis” (SAA) Focus, developed by CARE USA, whose objective is to address social, economic and cultural factors that influence health within the Programming Cycle shown in this graph.
The first step of the SAA focus is Transforming the Capacity of CARE Staff, therefore, a CARE Honduras Health Sector staff representative participated in the Workshops facilitated by the CARE USA Sexual and Reproductive Health Unit in Kigali, Rwanda. In this workshop, the “Ideas and Action” Manual was made known as well as deepening on the SAA Focus. Through skits, reflection and dialog on the subject of Family Planning, the prejudices’ and attitudes of the participating staff who would later be responsible for the coordination and assurance of implementing the Social Change and Knowledge Exchange initiative in each country were questioned.
The general objective of the “Youth and Family Planning” Initiative in Honduras is to get to know the social conditions of sexually active youth (men and women) between the ages of 15 and 24, that challenge family planning in 5 Municipalities of the Department of La Paz, where CARE Honduras has health interventions.
The specific objectives of the initiative are:
- Identify social factors that intervene or facilitate the use of modern/traditional family planning methods en youth (men and women) between 15 and 24 years of age in 5 Municipalities of the Department of La Paz.
- Document and Exchange information created by the social analysis, both within and outside CARE, as input to improve sexual and reproductive health conditions regarding family planning in youth between 15 and 24 years of age.
- METHODOLOGY USED.
The first step in the intervention area was to coordinate with the Ministry of Health of Honduras, specifically with the Health Department of La Paz in order to create awareness regarding the Social analysis and Action Approach with the institutional health personnel working in the municipalities of the intervention area.
The health personnel was very much in agreement that the first step is to Transform the Capacity of Staff recognizing that social change starts from within by challenging ones own prejudices before questioning the prejudices and inequities of power and gender in the communities where they are working.
It was also emphasized that for the success of the next steps of the SAA Program Cycle it is of great importance that the health institutional staff should work together with the community taking the community into account during each process of this cycle.
During the working session between CARE and the health institutional staff (Doctors, Professional Nurses, Assistant Nurses, Teachers and FP Coordinator) from the 5 municipalities of La Paz, the proposal of the ¨Youth and Family Planning” Initiative was revised, as far as geographical area, target population and time-schedule of the actions of the initiative. As a result of this revision, the need to add the Municipality of Marcala was identified, as this is a municipality with a large population, registering a high percentage of early pregnancies and with a Child-Maternal Clinic in the urban center. Therefore the program will be assisting a total of 6 municipalities: Santa Ana, Santa Elena, Opatoro, Yarula, Guajiquiro and Marcala.
A second change made before implementation was to include youth from the age of 14 (and not starting at 15 as was initially decided) in the community reflection meetings, due to the Ministry of Health reports and population census in the area reporting cases of pregnancy and couples living together starting from that age.
Later, step #2 of the SAA Program Cycle was implemented, consisting of the “Community Reflection”.
In order to reach the communities, the CARE personnel defined Marcala as its headquarters[2] and commuted to the communities every day, spending between one hour and one and a half hours a day travelling to these municipalities, along dirt roads with little or no road maintenance.
Guajiquiro Community – La Paz
CARE[3] colleagues working with the HOGASA (Homes Managing Health) and Chagas Prevention Projects, joined the meetings. These colleagues are working in the Department of La Paz as a strategy to make other CARE Health Sector staff aware of the SAA approach. Additionally, the support of this staff during the workshops enabled the facilitator to dedicate more time to register information and comments from the participants. The participation and presence of nursing personnel was also strategic during the reflection meetings with the community as they listened to the voice of their communities and identified with the needs regarding FP services.
To date there have been a total of 6 meeting with Youth, and 5 meetings with Health Volunteers. The reflection meetings with the communities were6 hours long, from 9 am to 3 pm, considering that the majority of the participants walk from their communities, towns, or hamlets to the Health Center, which takes some of them 30 minutes as much as one and a half hours walking along dirt paths and short-cuts both coming and going, due to the lack of access to transport (one trip a day or no transport).
The reflection meetings with the community took place through dialogues with groups of youth (together and separated by gender) and with groups of health volunteers coming from different communities in the 6 municipalities of the area of influence. Each meeting was carried out with an average of 10 to 14 participants, which enables listening, learning, challenging, exploring, reflecting and taking notes of the comments and suggestions of the participants. The following was the meeting agenda:
Activity / Method / Schedule / In charge of(Municipality - Marcala)
Materials delivery. / Glenda Osorio - CARE
Welcome and Purpose of the workshop. / 9:00 – 9:15 / Dr. Francisco Dubón – Ministry of Health
Participant introductions / 9:15 – 9:30
Presentation exercise on Family Planning Methods. / Individual questions and Plenary / 9:30 – 10:15 / Lic. Dacia Ramírez
CARE
COFFEE BREAK / 10:15 – 10:30
Family Planning Methods (natural, barrier and permanent) / Exhibits / 10:30 – 11:30 / Licda. Norma Reyes
Ministry of Health
Problem Tree Energizer / Brain storming / 11:30 – 12:15 / Lic. Dacia Ramírez
CARE
LUNCH / 12:15 – 12:45
Problem Tree Energizer …continues. / Group work
Presentations / 12:45 – 1:30
#2 Exercise; Reflection / Group work
Paper boards / 1:30 – 2:15
Role playing in Family Planning / 2:15 – 3:00
Conclusions / 3:00 – 3:30
As can be seen in the meeting agenda, the explanation of the methods of family planning was included after exploring the knowledge and beliefs of the Group on this subject, which allowed clarification of doubts and myths and to receive appropriate information.
In the next period (March to June 09) the Workshops in the municipality of Santa Elena should be carried out, and progress made towards step No. 3 of the SAA Program Cycle, corresponding to the Action Plan for which a meeting with the health institutional staff is planned to revise the findings and prepare a proposal profile for family planning.
- FINDINGS
- Youth:
The majority of the youth participating in the reflection meetings were high school students (Middle School Seventh to Ninth Grade or Seventh Grade of the Social Promotion Baccalaureate) and very few at university level. In some of the cases, mainly boys, were working youth, (generally agriculture or coffee picking), women dedicated only to domestic chores were also present. The youth mentioned that their most frequent pastime was “listening to all kinds of music” for both sexes, and less frequently practicing a sport such as soccer, was mentioned.
a)Beliefs and knowledge of youth on family planning.
A variety of positive comments related to family planning was obtained; the majority of the youth defined it as a method:
- For a couple to avoid having unwanted children.
- There are different methods for planning.
- It is a good method to avoid pregnancy.
- It is important for poor families not to have many children.
- It is a method for having few children and giving them a good education.
- It is a method for planning the number of children that you want to have.
- It is a method that is used so as not to have un-wanted or un-expected children.
- The FP methods are important for low income couples.
- They help in spacing out pregnancies.
- They are very secure methods.
- The FPM can be used both by women and men.
Among the comments from the Group of boys, regarding FP were the following:
- It is to inject oneself so as not to have children.
- Those who inject themselves for planning may become gay.
The youth also stated that there are people in their communities who are opposed to FP because in their opinion, it is bad to plan because it brings problems to the couple, risks to the woman, and one should have the children that God decides to give them.
The FP methods mentioned by the youth were the injection, the male condom, the IUD (Intra Uterine Devise) the pill, the operation, the ring and the collar.
Group Work Practice for using the condom
Santa Ana – La Paz youth. Opatoro – La Paz youth
b)Importance and benefits of family planning according to the youth.
They showed their knowledge regarding the benefits and importance of FP by expressing the multiple reasons listed below:
Not to bring children into the World for them to suffer.
Not to be single mothers.
With few children they can receive a better education.
Prevent child mortality.
Not to have too many children.
A better future for the children.
Avoid early pregnancy.
Avoid un-wanted children at an early age or when you are married.
Avoid population growth.
A better prepared community.
Have a relationship with someone with no worry or risk.
Avoid the risk of catching sexually transmitted diseases, such as HIV-AIDS.
There are different methods to choose form, pills, operation, copper T.
Family Planning does not only benefit the women, men must also be aware of this subject.
It helps the economies of the country, the family and the community.
Less maternal and child mortality.
Better health care for the baby and mother.
It gives the couple more time to prepare to receive a new member in the family.
Allows more attention and care for the other children.
Allows having sexual relationships as often as one wants.
Less poverty.
c)The perception of youth regarding early pregnancy
The youth identified early pregnancy as a problem in their communities as a general consequence of having sexual relations from adolescent. They also mentioned the following:
It is a problem because if the minor does not have a job cannot maintain their children.
It is a problem because they are children and do not know what they are doing.
It is a problem because the woman has not yet developed fully.
It is a problem because a family cannot be sustained and the end result is putting more weight on their parents at home.
It is a problem because it is the woman that bears all responsibility; the majority of men are irresponsible.
It is a problem because if the youth is studying, they cannot continue to do so.
It is a problem because the girls are forced to marry older men.
It is a problem because it can cause the death of both (mother and baby).
It is a problem because as the result of step/father rape, youth curiosity or making sex routine.
It is a problem because it causes loss of reputation, particularly that of the woman.
It is a problem because some cases pregnancy is a consequence of rape by step-fathers or fathers.
It is a problem because the mothers have to work and to work not giving their children the right up-bringing.
It is a problem because due to curiosity youth “start having boy-girl-friends” (phrase used to signify that they have sexual relations).
Work GroupsRole Playing
Marcala – La Paz Guajiquiro – La Paz youth
Youth identified some reasons why sexual relationships take place Turing adolescent, among which:
Friends influence them, pressuring them to have sexual relations and they are harassed or made fun of if they have not had sexual relations.
It is typical for the boy-friend to ask the girl-friend for the “Prof. of love” and they feel pressured by the boy-friends (comment made by a young girl).