Comparing the Effectiveness and Costs of Alternative Strategies for Improving Access to Information and Services for the IUD in Ghana

This 29-page report, published by the Population Council, aimed to assess whether the goals of a project to increase the use of Intra-Uterine Devices (IUDs) in Ghana had been achieved. The project, initiated by the Ghana Health Services (GHS) and implemented by its USAID Community-based Health Planning and Services (CHPS) programme in collaboration with FRONTIERS and EngenderHealth, involved testing a variety of interventions to increase awareness of IUDs and improve access to the method. These interventions included training community health officers (CHOs) and community volunteers in conducting educational activities around IUDs and other long-acting family planning methods; and improving the CHOs' IUD insertion and removal skills. The key assumption in the project was that interpersonal communication and messages tailored to address community beliefs and fears were likely to stimulate demand for IUDs and other long-acting methods.

In addition to training CHOs on conducting educational activities and using IUDs, the project developed leaflets to provide basic and accurate information on the IUD, including how it works, and its advantages and disadvantages. The leaflet also answered common questions, presented points to remember, and explained the need for dual protection against HIV. According to the report, the material was developed through a consultative process with specialists, and was pre-tested in two peri-urban communities. A total of 5,000 leaflets were produced and distributed to CHOs along with family planning flip charts and IUD kits.

The education campaign included short plays written in two common local languages and performed by satisfied clients. These were recorded onto audio cassettes and distributed to the intervention zones to be taken to communities via mobile vans. The campaign also involved: community meetings; health talks at ante and postnatal sessions, outreach clinics, churches, secondary school and women's and men's fellowship group meetings; meetings with occupational groups such as hairdressers, drivers, tailors, and clients at bars; one-on-one counselling of family planning clients and individuals encountered at other places with the community; and general counselling on family planning at home visits.

The research found that CHOs exhibited adequate knowledge of and a positive attitude towards the IUD. Both male and female respondents had high levels of awareness about contraceptive methods, and there were no statistically significant changes in the proportion of CHOs who knew of at least one method between the pre-intervention and end line surveys.

The study also found that knowledge of long-acting family planning methods did increase significantly among all women who participated in the project. However, this increase was also found in the study's comparison group, which did not participate in the project, so the increase cannot be attributed directly to the project's interventions. There were also some problems regarding providers' attentiveness to clients concerns, whether perceived or real, as well as providers' misinterpretation of service instructions outlined in the National Reproductive Health protocols, indicating a need for continuous training and retraining. The study also found that although contraceptive prevalence remains low, the project did prompt an increase in contraceptive use among both men and women, particularly of long-acting methods like the IUD. Furthermore, the study showed a significant increase in the number of new clients provided with the IUD or implants.

The study concludes that although it is difficult to determine categorically the extent to which the project had an impact at the population level, the increase in numbers of new IUD and implant users, as well as other factors such as the low cost of the intervention model, suggest that training CHOs to educate communities about long-acting methods and enabling them to provide them at the community-level should be considered.