Cultivating Men's Interest in Family Planning in Rural El Salvador

This report from the Institute for Reproductive Health shares the strategy and evaluation data from a pilot project in rural El Salvador that tested the integration of family planning, including the Standard Days Method, into a water and sanitation programme as a strategy for increasing male involvement in family planning decision making and use. The organisations involved in the intervention proposed that integrating family planning into a resource management and community development project would facilitate male involvement by diffusing information, by referring men and women to services, and by expanding method choice to include the new Standard Days Method through networks established around issues men cared about and were already involved in. This article examines data from a community-based household survey to assess the impact of the intervention and found significant changes in contraceptive knowledge, attitudes, and behaviour.

Through its work in communities in El Salvador, Population Concern International (PCI) has identified access to family planning as critical to sustainable development. PCI "perceives a close relationship between resource management, community development, and family planning, and has identified the inability of couples to plan their families as a major concern in the communities where PCI works." PCI works closely with community-development organisations to construct water and sanitation systems and provide health education. Project activities include orienting water boards, training volunteers, providing group talks by PCI facilitators and by the Ministry of Health
(MOH) promoters, and directing volunteers to conduct home visits. Group talks offer information about management of environmental resources such as water and soil and about latrines.

PCI's strategy was to link the already-valued concept of protecting natural resources with the concept of protecting family health by means of spacing births. The organisation's planners hypothesised that integrating family planning discussion into a resource-management and community-development project would facilitate male involvement by linking family planning information and services with issues men already care about. PCI developed and tested a model of family planning provision called “Planning Together,” the title emphasising gender equity in decision making. The strategy included integration of family planning messages into water and sanitation education; community-based provision of condoms; introduction of the Standard Days Method; and referrals for other methods. Recognising that men learn about family planning from their peers and from the mass media rather than from formal health-care providers, PCI set out to reach men through informal community networks. Their strategy was designed to encourage positive attitudes toward family planning and male involvement by spreading information through community
leaders.

PCI conducted research in the communities to help develop the strategy. For example, according to baseline survey results, when asked whether they would like to receive family planning services individually or with their partner, 65 percent of women and 80 percent of men answered "together." PCI used these findings to design an outreach strategy and educational messages for incorporating family planning into their programme. The idea was that the water and sanitation programme structure would provide an informal network for diffusing information about family planning. PCI felt that capitalising on existing networks was essential because research indicates that informal social networks can be a powerful mechanism for changing attitudes.

Thus, family planning topics were integrated into ongoing educational activities conducted during the process of community mobilisation and construction of water systems and latrines. The key themes in the family planning messages included in the water and sanitation education programme were: the relationship between the protection of natural resources and the protection of family health through birth spacing; gender equity in making decisions about family and community resources; and the availability of a range of family planning methods to meet the particular needs of each couple. Simple drawings and trigger questions were used to stimulate discussion and transmit key messages. The messages were designed to help the community members understand the connection between the planning and protection of the family and the protection of natural resources. The objective was not to transform the water and sanitation project into a reproductive health project, but to awaken the interest of couples and motivate them to seek further information and services from family planning providers, including the Ministry of Health, Asociación Demográfica Salvadoreña, and community volunteers.

According to the report, people began talking about the issues even when they themselves were not directly exposed to a group talk or home visit from a PCI facilitator or community volunteer. This is an expected consequence of the strategy of involving community development boards and training volunteers in order to stimulate discussion and provide information on topics related to family planning in community meetings. Volunteers did not restrict discussion of these issues to planned home visits; they also raised them during informal conversations with friends and relatives.