ABSTRACT
Despite a steady emergence of family planning programmes and services globally, 214 million women in developing countries have the desire to control their fertility, but lack the means, access, and agency to obtain effective family planning (FP) services (WHO, 2018). Multiple studies have highlighted the importance of addressing socio-cultural barriers and norms to improve the uptake of essential Maternal, Newborn, and Child Health (MNCH) services. Engaging community leaders, including lay leaders (such as chiefs) and faith-based leaders (such as pastors, traditional religious practitioners, and imams), have been promoted to shift social norms and traditional practices and improve MNCH behaviours. The impact of faith leaders’ support in their communities for HTSP/FP through contraceptive use has never been systematically measured and compared against similar communities without similar support; a gap in evidence that still needs to be filled and which is important for programme implementation. World Vision implemented a three-year operational research project to measure change in contraceptive prevalence rate (CPR) among women of reproductive age in communities in which faith leaders—Christian and Muslim—were exposed to a behavioural change faith-leader specific model: the Channels of Hope (CoH) MNCH + HTSP methodology, as compared to a comparable community without CoH MNCH + HTSP interventions. Our study found that World Vision’s model for faith leaders had a substantial impact on faith leaders’ attitudes towards spacing of pregnancies and modern contraception, knowledge on and use of contraception among women of reproductive age, and community’s social norms, especially early marriage. Attitudes among Protestant Christian and Muslim faith leaders—based on solid understanding of health risks to mothers and newborns associated with pregnancy and birth—are positive towards reproductive health, including approval of modern methods of contraception. Using the difference-in-difference estimator after the intervention, it was determined the overall increase in mothers’ knowledge on at least three FP methods was 7.2%, with the intervention site showing change of 12.2% and the control site 5% from baseline to final surveys. Overall results seem to indicate that World Vision’s CoH methodology is a behavioural change model with high potential to influence community norms and attitudes towards reproductive health, and that it can be used to increase population-based demand for FP services because its main impact is at influencing consumers to use contraception methods.
