Leveraging Local Systems to Enhance Postpartum Family Planning in Tanzania: Baseline Findings

This blog was originally posted on EDI Global at Leveraging Local Systems to Enhance Postpartum Family Planning in Tanzania: Baseline Findings – EDI Global (edi-global.com)

Photos by Amani Dawai, Save the Children Tanzania. 

In Tanzania, adolescent and young first-time mothers (FTMs) face challenges in accessing postpartum family planning (PPFP) and other essential health services with barriers to accessing PPFP including lack of adequate information, economic constraints and cultural stigma which may prevent adoption of modern PPFP methods. With over a quarter of adolescent women aged 15-19 experiencing childbirth or pregnancy, and a low contraceptive use rate of 8.6%, addressing this issue is crucial for maternal health outcomes1. Working closely with the Ministry of Health, the Connect Project aims to tackle these barriers and increase PPFP services adoption among FTMs through light-touch, innovative interventions while strengthening existing health systems. These interventions include providing FTM-targeted PPFP content via community health workers in existing community support groups and use of SMS. 

Who is involved and what is the evaluation approach?  

The Connect Project is led by Save the Children in collaboration with the George Washington University (GWU) Milken Institute School of Public Health. EDI Global is the data collection partner in Tanzania.   

Beginning in 2019, Connect designed and tested the approaches in a pilot, and conducted a quasi-experimental evaluation (read more here). Lessons from the initial testing were integrated into a second roll-out of the approaches currently being evaluated. This impact evaluation involves a cluster randomized controlled trial (cRCT) to assess the causal impact and cost-effectiveness of the project’s community-level interventions on PPFP adoption and continuation among FTMs aged 14-25.  

Baseline surveys were conducted among 1,129 FTMs aged 14-25 between February 22nd and March 14th 2023. These surveys aimed to collect demographic data and baseline measures of key outcomes of interest, establishing a foundation for the subsequent evaluation. 

Why is there a need for attention on PPFP interventions?  

Many challenges are faced in scaling up and institutionalizing successful PPFP programs. By leveraging existing government health systems and community-level efforts, the project aims to address these by developing light-touch “enhancements” to promote PPFP use among FTMs (cite Connect website). 

The project’s significance lies in its potential to reduce barriers and increase access to essential health services for young FTMs.  

Study Location 

The study is taking place in Dodoma region of Tanzania.  Dodoma Region has a population of over 3 million and holds the country’s administrative capital city. Data from the 2016 Demographic and Health Survey reveals limited education attainment among women of reproductive age in the region with 28% unable to read at all and 54% having completed only primary education. The prevalence of early childbearing among 15-19-year-old girls is higher in Dodoma (38.5%) than the national average (26.7%). Current use of modern contraceptive methods among women of reproductive age in Dodoma is at 41.2%, with injectables and pills being the most commonly used methods.

Figure 1: Dodoma, Tanzania.

Source: MapChart.net

Sample Characteristics 

A total of 72 villages, within two largely rural districts of Dodoma region, were randomly assigned to treatment and control groups, stratified by district and urban, peri-urban, or rural status. 

The total sample of 1,129 FTMs contained 696 respondents (62%) aged 14-19 and 433 respondents (38%) who were aged 20-25. Those who were currently pregnant (N=302) for the first time comprised 27% of the sample, whilst 73% had given birth within the last 12 months (N=827).   

The study also explores decision-making agency of partnered FTMs. During baseline 64% of FTMs who had given birth within the last 12 months were partnered (married, engaged, or living together as if married) compared with 72% for FTMs who were currently pregnant.  

What did the baseline find about PPFP adoption and attitudes?  

The baseline data reveals a key message: there is room for improvement in PPFP adoption and the timing of adoption. Almost all (97%) of respondents said they want to space births by 2 or more years. Since giving birth, 45.9% of FTMs had adopted a modern PPFP methods and at the time of data collection 34.2% were currently using them. Most FTMs who had adopted PPFP, did so 3-6 months after giving birth, this presents an opportunity for interventions to increase early adoption. 

Among the FTMs who adopted PPFP, most used Lactational Amenorrhea Method (LAM, 32.4%), male condoms (36.1%), and implants (37.9%). Fewer FTMs adopted oral contraceptive pills (6.3%) and intrauterine devices (IUDs, 1.8%). There was also a low intention (2%) to adopt IUDs of those who have not adopted any modern PPFP. 

Relating to injunctive norms, FTMs perceive that their community thinks it is appropriate for young mothers with only 1 child to use modern contraception. Whilst 84% of FTMs agree that it is appropriate for a husband and wife to talk about family planning; only 50% of partnered FTMs have discussed family planning with their husband/partner. 

The baseline data serves as a starting point for exploring these trends, attitudes and practices further as well as assessing the effectiveness of the interventions. The Connect Project is paving the way to enhance PPFP uptake among young FTMs, potentially transforming maternal health outcomes in the region. 

Next Steps 

The endline survey for the impact evaluation has been conducted June-July 2024.. Following this, the research team will disseminate finds and work closely with the Government of Tanzania towards scaling sustainable and effective PPFP interventions. 

Conclusion 

These baseline findings mark an important milestone in the quest to improve maternal health outcomes in Tanzania. By addressing the unique challenges faced by adolescent and young FTMs in accessing PPFP and other health services, these approaches aim to strengthen local systems and create light-touch sustainable solutions. Through its innovative approach and rigorous evaluation, these approaches hold promise of positively impacting the lives of many young mothers in Tanzania. 

A community Health Worker (CHW) with First-Time Mothers (FTMs) in the Connect Project. Photo by Amani Dawai / Save the Children International Tanzania. 

For more information reach out to Sarah Baird at sbaird@gwu.edu with any questions or read more about the Connect Project here [https://resourcecentre.savethechildren.net/collection/the-connect-project/].