Reaching Young Married Women and First-time Parents for Healthy Timing and Spacing of Pregnancies in Burkina Faso

"According to data collected during baseline home visits by animateurs, 41% percent of YMW [young married women] at project sites were using contraception to delay or space pregnancies, while endline home visits found that 81% of YMW reported using contraception to delay or space pregnancy, suggesting that project activities at the individual, community, and structural levels contributed to the creation of an enabling environment for YMW to seek contraceptive services." This technical brief discusses Pathfinder’s experience in Burkina Faso, implementing a project to reach young married women (YMW), first-time parents (FTP), and their key influencers, for healthy timing and spacing of pregnancy (HTSP) through contraceptive use. The brief discusses the context, strategy, and implementation of the project, and how it helped to build knowledge on how to reach this hard-to-reach population.



The brief first discusses the Burkinabe context. Research showed that over half the female population between the ages of 20 and 24 were married by age 18, and that sexual activity and reproduction predominantly occurs within the context of marriage. At the same time, social and cultural norms often prevent YMW from accessing sexual and reproductive health (SRH) services. The Pathfinder project was developed to expand access to critical, timely, and appropriate information and services for YMW and FTP, as well as contribute to global knowledge about how to reach this population. Drawing on experiences from interventions designed to reach YMW and FTP in India (Promoting Change in Reproductive Behavior of Adolescents (PRACHAR) project) and Uganda (The Gender Roles, Equality, and Transformations (GREAT) Project), "Pathfinder developed a strategy that reached all levels of the socio-ecological model - individual, community, and structural — in order to foster changes in behaviors and norms around contraception use and HTSP among YMW and FTP."



Combining the PRACHAR and GREAT approaches in Burkino Faso, Pathfinder trained animateurs (community health workers) to reach YMW and FTP at their homes with individualised SRH information, counselling on HTSP and contraception, and couples communication, as well as to make referrals to health facilities. At the community-level, the project introduced small group discussions with YMW and FTP, as well as community theatre and group discussions with male partners and group discussions with key community leaders. At the structural level, the project integrated youth-friendly services at four facilities, trained providers, and disseminated national Adolescent and Youth Sexual and Reproductive Health (AYSRH) standards. Pathfinder and its Evidence to Action (E2A) project collaborated to design and implement an intensive qualitative monitoring and documentation process that put frontline implementers at the centre of generating, analyzing, and refining evidence during small group discussions.



According to the end of project assessment, during one year of implementation, the YMW-FTP project supported 650 YMW and hosted 40 small groups that held regular meetings, with 4,269 participations recorded in these meetings. Animateurs reported 1,923 home visits with mothers-in-law and key influencers and had 171 contacts with religious and traditional leaders to sensitise community members and share accurate SRH and HTSP information.



Qualitative analysis sought to understand and capture the processes, techniques, and knowledge of frontline implementers and local partners, which are discussed in the brief as lessons learned. For example, it was noted that implementers must first cultivate the engagement and support of key gatekeepers such as mothers-in-law, co-wives, and male partners who may sometimes be misinformed or have particular cultural expectations. In Burkina Faso, mothers-in-law have particular importance. "Many animateurs felt they were received differently during home visits when they addressed YMW first and when they addressed mothers-in-law first. As a result, frontline implementers recommend that implementers consider mothers-in-law as a primary target group that should be approached individually at the beginning of outreach interventions."



Similarly, findings suggest that while the role and influence of co-wives varied according to urban and rural settings, older co-wives seemed to consistently hold more influence than younger co-wives. "Frontline implementers recommend that implementers recognize the diverse relationships between co-wives and adapt strategies accordingly." Including co-wives in small group discussions, and speaking with them separately at home visits to listen to their concerns and needs, reduced barriers to reaching YMW and FTP. Another key learning was that male partners required different strategies to encourage participation in the project, implementers recommend “speaking to older husbands and YMW separately so that each feels comfortable expressing him or herself openly, while couples who are close in age responded well to couples’ counseling."



Overall, the project findings "confirm that implementers must engage and understand the social context around YMW and FTP, aligning their approaches specifically to the setting (rural or urban), and designing approaches to fit the relationship dynamics of YMW and FTP to those with most significant power to influence them." As well, systematic approaches to learning from implementation of interventions can offer our global SRH community critical insight into how to direct and refine future efforts. "The YMW-FTP project experience suggests this approach to implementation merits wider application."