Abstract
Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month increased from 14 to 37 and the percentage of family planning adopters choosing LARCs increased from 50% to 66%. While implants continued to be the most dominant method, reaching 60% of the method mix in 2016, the percentage of clients adopting IUDs increased each year, from 3% in 2014 to 13% in 2016. In total, 39,399 clients started family planning methods during the post-program design change period (2014-2016). Our experience in eastern DRC demonstrates that women and their partners affected by conflict want family planning, and that it is feasible to deliver the full range of modern contraceptive methods when programs are adapted and sensitive to the local context.
Highlights
Introduction of Immediate Postpartum intrauterine device (IUD)To increase opportunities for adoption of family planning, International Rescue Committee (IRC) began training and supporting providers to insert IUDs immediately postpartum in 2014
Unmet need for family planning in conflict-affected areas such as eastern Democratic Republic of the Congo (DRC) is as high as 38%
100,000 live births to 846 deaths per 100,000 live births between 2007 and 2013.3 Unmet need for family planning in conflictaffected areas such as eastern DRC is as high as 38%
Summary
To increase opportunities for adoption of family planning, IRC began training and supporting providers to insert IUDs immediately postpartum in 2014. Directly or indirectly, clients to choose the method whose duration of efficacy matched their desired birth spacing duration, without adequately informing them of the ability to remove long-acting methods whenever the clients wished This practice may have made clients less likely to choose the IUD because they wanted to space for fewer than 10 years. Unmet need for family planning in conflict-affected areas such as eastern DRC is as high as 38%. Civilians have frequently been targeted by rebel and government armed groups, whose human rights abuses are well-documented.[9]
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