Lauren VanEnk, MPH, Program Officer at the Institute for Reproductive Health at Georgetown University discusses conducting and using research from FBOs on the family planning services they provide in Uganda at the CCIH 2018 conference.

1. What does research have
to do with it?
Lauren VanEnk
Institute for Reproductive Health
A discussion around conducting and utilizing research with
FBOs through the lens of an assessment of family planning
services in Uganda

2. Overview
1. What’s the current status of research
about faith and family planning?
2. Why did we conduct a study with FBOs
in Uganda and what did it explore?
3. What did we learn about family
planning and FBOs in Uganda?
4. What did we learn about doing
research with FBOs?
5. What should the future of research look
like for faith and family planning?

3. What published literature exists?
• Widmer, et al. The role of faith‐based organizations in
maternal and newborn health care in Africa, 2011
• Campbell, O. Who, What, Where: an analysis of private
sector family planning provision in 57 low- and middle-
income countries, 2015
• Christian Journal for Global Health, Family Planning
Supplement, 2017
• Barden-O'Fallon. Availability of family planning services
and quality of counseling by faith-based organizations: a
three country comparative analysis, 2017
• (Ongoing) IRH study on family planning counseling in
Uganda
• (Ongoing) IRH study on Transforming Mascilinities, a social
norm intervention with protestant churches in DRC

4. Uganda Protestant
Medical Bureau (UPMB)
Uganda Catholic
Medical Bureau (UCMB)
• Belong to a network of private not-for-
profit service delivery institutions in
Uganda
• Provide ~35% of health services and
70% of health training institutions

5. Research Design
Research Objectives:
1. Describe the experience of clients receiving family
planning services from UCMB and UPMB facilities
from a quality of care perspective.
2. Describe the behavior of new family planning users
who receive counseling at UCMB or UPMB facilities.
3. Understand couple perceptions, attitudes, and
behaviors related to family planning.
Sample: Clients accepting user-directed methods
(SDM, TwoDay, injectables, or oral contraceptive pills)
Data Sources:
• Initiation interview (immediate)
• 1st follow-up interview (3m)
• 2nd follow-up interview (6m)

6. 43%
38%
36%
16%
Closest facility Provides the best
care
Offers services
needed
Received care here
in the past
Why clients chose faith-based facility
FP CLIENTS SEEK SERVICES FROM FBO SITES FOR
NUMEROUS REASONS.

7. RESPONDENTS KNEW THE SITE WAS AFFILIATED WITH THE
[CATHOLIC/PROTESTANT] CHURCH
n=310
88%
12%
Yes
No

8. PREVIOUS METHOD USED BY RESPONDENTS
ACCORDING TO CURRENT METHOD
0
25
50
75
100
Standard Days
Method (N=186)
TwoDay Method
(N=66)
Contraceptive pill
(N=13)
Injectables (N=34)
PreviousFPmethod
Family planning method selected during counseling session
No Method
Withdrawal
Condoms
LARCs
Injectable
Pills
FAM

9. MEASURING QUALITY
• Client satisfaction
• Does the provider offer client-centered counseling by taking stock of her health & personal history?
• Does the provider offer informed choice counseling?
• Does the provider offer correct and sufficient information about how to use the method?

10. MOST CLIENTS ARE SATISFIED WITH FP
COUNSELING AT FBO SITES.
Catholic n=196
Protestant n=106
33%
54%
57%
41%
9%
3%
1%
3%
1%
0%
Catholic
Protestant
Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied

11. HEALTH & PERSONAL HISTORY
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Medical
history
Desire for
children in
the future
Time living
with partner
Partner's
attitude
toward FP
Previous FP
use
knowledge
of FP
methods
Interst in a
particular
method
Concerns
about FP
Responded
to concerns
Reasons
some
methods
might not
be
appropriate
UCMB UPMB

12. METHOD
INFORMATION
INDEX
1) Were you informed about other
methods?
2) Were you informed about side
effects?
3) Were you told what to do if you
experienced side effects?
53%Of clients
reported all 3
nationally
(UDHS 2015)
83%Of FBO clients
reported all 3
(IRH study)
V.

13. INFORMED CHOICE: AVERAGE
NUMBER OF METHODS DISCUSSED
BY SITE
7.6923
3.4000
7.7083
8.5128
8.1429
7.3871
0
5
10
Site A Site B Site C Site D Site E Site F

14. INFORMED CHOICE: PRESENTATION OF
METHODS
0
25
50
75
100
Presented some methods more favorably Presented some methods less favorably
Site A Site B Site C Site D Site E Site F

15. INFORMATION PROVIDED ABOUT METHOD USE
0
25
50
75
100
How to use method Possible side
effects/problems
How to deal with
side
effects/problems
Asked to repeat
important
information
Method does not
prevent HIV and STIs
SDM TWODAY PILL USERS INJECTABLE

16. CORRECT USE, CONTINUATION
& MALE INVOLVEMENT

17. CORRECT USE OF METHOD
SDM
N=149
TWODAY
N=48
INJECTION
N=24
PILL
N=8
Abstained or
used a condom
on fertile days in
the past month
Abstained or used
a condom on
fertile days in the
past month AND
checks secretions
at least twice a
day
Received an
injection within 90
days after previous
injection
Takes a pill once a
day, at the same
time every day, AND
has not missed
taking a pill at the
correct day and
time in the last
month
85% 83% 96% 3/8*
*Percentages are not used for pill users due to the small sample size.

18. MOST FBO CLIENTS USING SHORT-TERM
METHODS CONTINUE USE AT 6 MONTHS.
85%
94%
82% 82%
3%
18%
12% 6%
18%
SDM (n=158) TwoDay (n=47) Injectable (n=34) Pill (n=11)
Discontinued use of
method (not using
any method)
Transitioned to a
new method
Still using method at
6 months

19. MALE PARTNERS ARE INVOLVED IN METHOD
USE, MOST OFTEN WITH FAM.
SDM
N=149
TWODAY
N=48
INJECTION
N=30
PILL
N=8
94% 88% 57% 6/8*
• Reminds me to
move ring
• Abstains on fertile
days
• Uses condoms on
fertile days
• Abstains on fertile
days
• Reminds me to
check for
secretions
• Asks me if we can
have sex
• Reminds me when it
is time for another
injection
• Gives me money to
purchase injection,
for transport to
health facility, and
for soft drinks during
the journey
• Reminds me to
take pill
• Gets refill for me
• Buys soft drinks
to use while
taking the pills
*Percentages are not used for pill users due to the small sample size.

20. 9.27 9.77
8.91
6.44
9.72
10.87
7.73
7.00
Standard Days
Method
(N=152)
TwoDay
Method (N=47)
Contraceptive
pill (N=11)
Injectables
(N=32)
Relationship quality score at method initiation
Relationship quality score at three months
*
**
IMPROVEMENT IN RELATIONSHIP SCORES FOR FAM USERS
WAS STATISTICALLY SIGNIFICANT AFTER 3 MONTHS.
*p<0.05
**p<0.01

21. CONCLUSION
• Clients had positive perceptions of the
counseling session
• Improvements are needed re
informed choice counselling across
sites (Catholic sites need further strengthening in
some cases)
• Correct use and continuation of user-
directed methods was high
• Men were engaged in FP
communication, decision making, and
use - most often when using FAM
FBOs can provide quality FP counselling
leading to client satisfaction, correct use,
continuation, and male involvement.

22. Conducting research
with FBOs

23. Tips
• Introduce the study to key
stakeholders
• Include local partners in study
design, analysis, and publication
• Balance confidentiality with
information-sharing in the field
• Tailor methods and instruments to
faith context

24. A research agenda
for faith and family
planning
What do you think?