Evaluation of 2 Intervention Models to Integrate Family Planning Into Worker Health and Livelihood Programs in Egypt: A Difference-in-Differences Analysis.

Abstract

Recent increases in fertility rates in Egypt and an increase in desired fertility among unmarried young people highlight the need for renewed attention to awareness of and demand for family planning (FP) among young people. Between 2017 and 2018, the United States Agency for International Development-funded Evidence Project tested 2 intervention models to increase awareness of and demand for FP and reproductive health (RH) services among people aged 18-35 years in Souhag and Port Said governorates, Egypt. In Souhag, FP/RH information was integrated into a 5-day livelihood training program for job seekers. In Port Said, garment factory workers received FP/RH information through trained peer educators, social and behavior change materials, and social media. Workshop participants and factory workers interested in FP services were referred to private project-trained physicians and pharmacists. We present the results of an evaluation of the impact of each intervention on young people's reported exposure to FP messages and their FP knowledge, attitudes, and behaviors. Phone interviews were conducted with participants in intervention and comparison groups before and after the intervention. In Souhag, 1,519 intervention group participants (778 at baseline; 741 at endline) and 1,082 comparison group participants (699 at baseline; 383 at endline) completed the phone interview. In Port Said 1,958 participants from intervention factories (1,145 at baseline; 813 at endline) and 1,047 participants from comparison factories (621 at baseline; 426 at endline) completed the phone interview. A difference-in-differences analysis compared intervention and comparison groups between baseline and endline. Results showed significant differences in knowledge and attitudes over time between the intervention and comparison groups in Souhag but less so in Port Said. FP use did not change among project participants in either governorate. We discuss lessons learned from integrating FP into worker health and livelihood training programs and methodological considerations for evaluating such interventions.