It’s World Contraception Day: Let’s improve knowledge & informed choice

On World Contraception Day this year, we’re reflecting on the expression ‘Knowledge is Power.’ When it comes to reproductive health, knowing your body and how it works is critical to making healthy choices. Today, we continue to see high rates of unplanned pregnancy around the world and here at home. We long for a world in which women and their partners can achieve pregnancies that are planned and healthy. At IRH, we believe knowledge about fertility is a building block to achieving this vision.

Here are three ways IRH is striving to accomplish this:

1.  Studying how people’s knowledge about fertility impacts their family planning use

Through the USAID-funded FACT Project, we hypothesize that increased fertility awareness improves family planning use. To test this hypothesis we are developing interventions with our partners in India, Nepal, Rwanda, and Uganda to improve people’s knowledge about their fertility (e.g. menstrual cycle, when and how pregnancy occurs, the likelihood of pregnancy from unprotected intercourse at different times during the cycle and at different life stages, and the role of male fertility). We will then study how this knowledge impacts their family planning use. These results will help inform how family planning and reproductive health programs are designed. We hope that by building the evidence base in this way we will improve the effectiveness of programs and help more couples make informed choices about their sexual and reproductive health.

2.  Empowering women and improving couple communication through knowledge about their bodies

Results from studies in numerous countries have shown that few women and men really understand their fertility and that this lack of knowledge constrains their ability to protect their reproductive health. However, couples who begin using a fertility awareness method of family planning, like the Standard Days Method® (SDM), improve their understanding of how fertility works. Fertility awareness methods are inherently information-based. Hence, users of these methods grow in their knowledge about their own bodies and their partner’s. With knowledge comes confidence.

User experience suggests that SDM use is empowering for many women. They report that knowledge about their bodies and menstrual cycles and being able to prevent unwanted pregnancies has increased their self-confidence and their ability to care for their health.  Because SDM depends on couple cooperation it also engages men actively in family planning—through outreach, counseling and practice. Both male and female SDM users report that communication between the couple improved as a result of using SDM.

“Ever since using SDM I have noticed many positive changes for myself and my relationship. I have a better understanding of the way my body works, including fertile and infertile days, something I never thought about before. SDM is a very discreet method. It provides great autonomy in the way we manage our relationship. It does not require any resupply from the health agent or any follow-up appointment at the health center. Physical sex with my husband has become more harmonious. SDM has breathed new life into our relationship. That is the most significant change. Ever since we adopted this method we only rarely need to put up with the constraints of wearing a condom, and this suits us perfectly.”
– Female SDM user, Mali

“For me as a midwife, I learned about the menstrual cycle which could have helped me so much to monitor myself, but I used to fear it. [The] menstrual cycle is not an easy topic, I used to fear it at school, but with this family planning [FAM], I am just very okay with the knowledge, I find it so simple, and I can really teach other people.”
– Provider and user of FAM in Uganda

3.  Increasing adolescent self-efficacy to manage puberty changes

Between the ages of 10 and 14, girls and boys are beginning to solidify their sexual and gender identities and develop attitudes and skills that lay the foundation for future reproductive health and wellbeing. For example, the onset of menstruation can be an abrupt transition into adulthood for young girls. Across most cultures, stigma and taboos related to these natural puberty changes can have harmful effects. A study in Rwanda found that 40% of young girls miss school regularly due to menstruation.

In Rwanda, we are addressing this challenge with an initiative called GrowUp Smart.  GrowUp Smart is an interactive puberty education program curriculum for very young adolescent girls and boys that introduces them to sensitive topics such as fertility, menstruation, gender, hygiene, safety and communication in an age-appropriate way. GrowUp Smart is a new approach that draws on several of IRH’s innovative, evidence-based youth resources, like the GREAT Project’s Growing Up GREAT! flipbooks and the My Changing Body curriculum. GrowUp Smart not only seeks to bring about change at the individual and family level but at the community level. We’re measuring knowledge, attitudes, and behaviors of 3,500 adolescents and their parents on topics from the curriculum through pre- and post-intervention surveys. Growing evidence suggests adolescents who are knowledgeable about their body and fertility are able to communicate about these topics with peers and adults and develop increased self-efficacy to obtain sexual and reproductive health services as they need them.

Ask parents where darkness obscures knowledge
Don’t be scared of them, tell them!
Be bold asking constructive questions
Showing at the same time politeness
The identity of a GrowUp Smart boy or girl

Be confident, boy, girl in puberty,
Be skillful and talk in wise ways,
Ask much and gain knowledge,
Knowledge about our body changes
GrowUp Smart Rwandan woman
Kindness is part of Rwandan woman
But children under GrowUp Smart
They excel in every discipline

– Poem written by Rwandan Adolescent, GrowUp Smart Participant

Join us at ICFP to keep the conversation going about:

Working with very young adolescents

• Poster Session 3: GrowUp Smart: Talking about changing bodies to empower girls, boys and parents for sexual and reproductive health over the life course

The impact FAM has on clients and programs

• Beyond resupply: CHWs’ experience offering Standard Days Method to new users in Rwanda
• What Counts in Contraception – Getting to FP2020 (Putting the Modern in the Reporting of SDM and LAM)
• Holistic care: How faith-based organizations are integrating family planning into development programs
• Access, Contraceptive Choice and Human Rights: Challenges and Tensions
• Faith-Based Health Leadership in Africa: An Integral Part of Improving Family Planning and Reproductive Health

Fertility awareness and body literacy

• Marketplace of Ideas: Unveiling the mysteries: Confronting our misconceptions about menstruation, fertility, sex, and family planning
• The linkages between Fertility Awareness and Family Planning Uptake: Program findings of scaling mHealth services in India