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Building family resilience through economic empowerment, healthy timing and spacing of pregnancies, and gender equality

Building family resilience through economic empowerment, healthy timing and spacing of pregnancies, and gender equality

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Lauren commented on Rise Together

Funding for the design and proof of concept testing phase of RISE Together initially came from USAID through the Fertility Awareness for Community Transformation Project (2013-2018). Initial results show that non-healthcare providers like YLP group facilitators are able to offer community learning sessions on key topics like fertility and child spacing and provide family planning counseling in group settings. These results were assessed after an 11 month intervention period. With these fresh results, the team seeks to strengthen the emphasis on livelihood skills for group members and gender equality so that couples will have the information, skills, and access to services that allow them to plan and support their families.

RISE Together draws on learnings from the Gender Roles and Equality Transformation (GREAT) Project, a recently ended USAID-funded project in Northern Uganda. The GREAT Project’s approach was to address and transform harmful social norms related to gender, violence and reproductive health in Northern Uganda through a toolkit of interactive games, a radio drama, and critical reflection with adolescents (10-19). RISE together benefits from this experience by learning from formative research and social and behavior change approaches established by GREAT. However, RISE together targets an older audience of youth which in Uganda is defined as 18-30. This group of men and women are entering critical transition phases in their life such as marriage and parenthood. In order to address systemic poverty, these couples need the information, skills, services, and social support to decide when to have children and how to provide for them.

RISE Together is a solution design that has undergone proof of concept testing and initial pilot testing in Northern Uganda. Based on these results, the team sees a need for further iteration to enhance the connection with livelihoods and build the capacity of YLP groups as they also address concepts of healthy timing and spacing of pregnancies and gender equality. RISE Together is the first group counseling intervention for family planning conducted outside the formal health system. There is strong evidence documenting the impact of expanding access to family planning to the community level, but there is little evidence showing the feasibility of offering these services in a group of multiple clients. Group counseling for family planning has the potential to address social barriers to uptake, encourage correct method use through social support, and maximize the provider-client counselling time in a setting where family planning counseling is just one of many responsibilities performed by the provider. Small scale service delivery initiatives suggest fertility awareness methods (FAM) can be taught in a group setting, even in contexts with low literacy. In the context of low resource settings—where women may not have access to health services —a group learning approach meets both the local need and cultural context for sharing key information. As FAM are information-based and natural family planning methods, disseminating information about the methods and facilitating potential uptake is possible within group settings, unlike other family planning methods. Therefore, increasing access to and use of FAM through existing groups and social networks offers a unique opportunity to go beyond the health system to address unmet need for family planning in areas that desperately need services. FAM options are included in the government of Uganda’s family planning norms and are considered modern by WHO and USAID. Linkages with the formal health system will continue to be emphasized through orientations with facility staff and the provision of family planning invitation cards during RISE Together community learning sessions.

As part of the monitoring and evaluation plan, provider competency in method counseling, correct use of methods by clients, and overall uptake of family planning is assessed. In subsequent iterations of the design, the team would like to conduct a community survey to measure broader social change and improvements in well being from the intervention, e.g. gender equitable norms, family planning attitudes, economic security, food security, and community participation. Relationship dynamics (e.g. shared decision making, communication, partner support, etc.) will be assessed among couples who participate in group learning sessions and take up a method of family planning.

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Lauren commented on Rise Together

Hi Kate, Sheku, and Vicki,

Thanks so much for your interest in and contributions to this project!

Kate and Sheku, you asked where we think this project will be in the near future. Great question. Right now, this project has gone through proof-of-concept and a small pilot testing phase. It’s showing promising results so far, especially around improved knowledge, positive attitudes around healthy timing and spacing of pregnancies, and increased uptake of family planning. Youth facilitators from the microfinance/livelihood groups reach out first to their village members with the community learning and group counselling sessions. They were able to achieve coverage of their village over the course of a few months. Ideally, the activities would be expanded to other villages once the majority of community members were reached. We would expect that each pair of youth facilitators could easily cover a village every six months. Depending on resources and project time frame, a group of 25 youth facilitator pairs could cover 50 villages within two districts in Northern Uganda in a year. We would also like to incorporate into the approach a mentoring component where current youth facilitators mentor new youth facilitators to take on and expand the activities even further. It’s important to note that the youth facilitators are volunteers so expectations for such activities need to be manageable within their daily activities in order for the model to be sustainable.

Sheku, your work sounds really valuable. We completely agree with the importance of male involvement and recognize that women’s decisions are never made in isolation. Your questions about male involvement and cultural acceptability are key. We strive to include both men and women in our work, especially considering that areas of reproductive health and women’s empowerment often focus solely on women. The microfinance/livelihoods groups are co-ed themselves which encourages a collaborative rather than competitive environment for economic empowerment. Rise Together uses a pair of youth facilitators - one male and one female - to more easily engage both sexes during community learning sessions and group counseling. Another major component of the project is stakeholder involvement, particularly religious leaders. Religious leaders and other influential cultural leaders will be invited to participate in sensitization workshops where they will be equipped with information and skills on gender equality, family planning, and couple communication. After engaging in critical reflection and dialogue on these issues, they’ll return to the community with new information and perspectives to share with their followers. They’ll be included in routine intervention activities and asked to share their perspectives along the way.
In the pilot testing phase, Community Development Officers in the district were also oriented on the approach which allowed for local ownership and enabled them to provide supportive supervision to the youth facilitators. They also supported linkages with health facilities so that youth facilitators could offer referrals for health services when needed.

Vicki, in our design and pilot testing phase we worked very closely with Save the Children to implement these activities. The local microfinance/livelihood groups were selected from among existing, self-governed groups in Northern Uganda who agreed to participate. During the pilot-testing phase, we worked with these groups to incorporate topics like body literacy, healthy timing and spacing of pregnancies, and gender equality. Based on this experience, we believe that the intervention could be even more robust by strengthening areas around gender equality and investing in the current activities of the microfinance/livelihood groups. Economic empowerment is a combination of power and agency as well as economic advancement. Power and agency are consistently addressed across each component of Rise Together from community learning sessions where harmful social norms are identified and discussed to supporting women to plan and space their births. We envision that economic advancement is possible though strengthening both human and financial capital of community members. Vocational training in entrepreneurial skills, the use of new technology, or the management of assets like livestock would improve human capital. We will also seek to extend the reach of microfinance opportunities to additional villages using the mentoring approach mentioned above to further support financial capital.