Case Study: SBCC Implementation Kit Helps Communities in Niger Communicate about High-Risk Pregnancies

“The content and structure of the I-Kit helped MSI-Niger enhance communication with communities – including through mass media – and with women and couples at risk.”

This case study looks at the results of a pilot project which used the healthy timing and spacing of pregnancy (HTSP) advanced maternal age (AMA)/high parity (HP) Implementation Kit (I-Kit) to increase adoption of modern contraceptive methods by at-risk women and couples in Niger. The I-Kit is a tool developed by the Health Communication Capacity Collaborative (HC3) to help programme managers implement social and behaviour change communication (SBCC) activities that address the topic of AMA/HP pregnancy. The pilot project was implemented by Marie Stopes International (MSI) Niger, an organisation offering reproductive health information and services in the regions of Niamey, Tillaberi, and Maradi.

The HC3 is a five-year, global project funded by United States Agency for International Development (USAID) to strengthen developing country capacity to implement state-of-the-art health communication programmes. Among other health areas, HC3 works in family planning on topics such as HTSP. As explained in the case study, “[G]lobal HTSP activities have focused largely on preventing closely spaced and early (i.e., before age 18) pregnancies. Much less attention has been given to the dangers of having too many pregnancies, or having children later in life.” In 2014, HC3 completed a desk review on knowledge and attitudes around AMA and HP pregnancy in low- and middle-income countries and an evidence review and secondary analyses of Demographic and Health Survey (DHS) AMA and HP Niger and Benin data. In 2015, HC3 conducted qualitative research and quantitative secondary analyses to understand the factors driving such risky pregnancies in Niger and Togo (see Related Summaries below).  Based on this research, HC3 developed the HTSP AMA/HP I-Kit which includes a series of adaptable tools, including:

• a client brochure (one for less conservative audiences and one for more conservative audiences);
• a counseling and assessment guide for providers;
• a counseling and assessment guide for community health workers;
• a reminder poster for facility-based providers;
• a guide for journalists;
• a guide for researchers;
• AMA and HP infographics for policy and decision-makers; and
• a guide for working with community-based groups.

As explained in the case study, MSI-Niger works primarily through a static clinic in Niamey, four mobile teams (i.e., a midwife, assistant and driver), Marie Stopes Ladies (mobile midwives sent to health posts and youth centers), social mobilisation agents (Agents de Mobilization Sociale – AMS), and community-based promoters (Relais Communautaires – RECOs). Mobile teams provide services in Minstry of Health (MOH)-operated health centres that would not otherwise provide birth spacing services.  The case study explains that although the team had social mobilisation expertise, they lacked SBCC experience. So, in 2016, HC3 awarded MSI-Niger $5,000 to pilot the HTSP I-Kit over a four-month period (July to October 2016). MSI-Niger used this funding to help mobile health providers, AMS, RECOs, and journalists to communicate clear, simple AMA and HP messages as a way to increase adoption of modern contraceptive methods by at-risk women and couples. As part of the activities supported by the I-Kit, MSI-Niger held a one-day workshop with eight journalists to gather their feedback on the journalist guide contained in the I-Kit, as well as orient journalists to AMA and HP pregnancy risks and to encourage them to report on it. The project team also used the I-Kit to orient managers and train five mobile providers and five AMS, who in turn trained RECOs. In addition, the I-Kit helped mobile teams integrated AMA/HP counselling into their normal service provision.

The case study looks at what aspects of the pilot were successful. For example, of all the I-Kit components, the journalist guide and workshop provided project managers with the most immediate result and the most satisfaction. Radio, television, and print journalists attended, participated actively, and expressed interest in reporting on this important topic.  Using the I-Kit also helped MSI-Niger service providers focus more on older and HP women and their needs. Prior to the I-Kit pilot, they rarely if ever spoke to clients about the risks of AMA and HP pregnancies.

Based on the pilot project, the case study makes the following recommendations on how to improve on the I-Kit and adapt it for the Niger context (discussed in more detail in the case study):

• Adapt materials for low-literacy clients by including more pictures, especially on AMA and HP complications.
• Develop materials for delivering messages to large groups, such as flip charts, as many of the materials contained in the I-Kit were designed for one-to-one counselling sessions.
• Revise the terminology to better align with Niger’s cultural and religious norms.
• Develop materials for men and religious leaders as, given Niger’s strong adherence to cultural and religious traditions, men and religious leaders need a special focus in birthspacing discussions.
• Plan for more training and practice sessions to cover new material.
• Help providers develop skills to tailor messages to individual clients instead of trying to follow the “script” provided in the counselling guide.