By Fiona Mills, Sexual and Reproductive Health (SRH) Consultant, PSI Cambodia, Dr. Kheng Heng, SRH Director, PSI Cambodia, Shirine Mohagheghpour, Senior Technical Advisor – Service Delivery, PSI
In 2014, 18 percent of married women in Cambodia used traditional contraceptive methods, an increase from 5.3 percent in 2000.
But as the evidence proves: relying on traditional methods only increases the risk for method failure. Women needed trusted health information and quality services to make the reproductive health decisions that are right for them.
Over the past decade, PSI’s Women’s Health Project (WHP) has supported Cambodia to double its modern method contraceptive prevalence rate by expanding high-quality sexual and reproductive health (SRH) services—including access to long-acting reversible contraceptives (LARC).
Following the conclusion of the PSI Cambodia-led and anonymous donor-funded WHP project, we’re reflecting on what we’ve learned and what we’re taking forward to ensure women’s continued access to SRH services and information – in Cambodia, and beyond.
- To generate demand for LARC, start by addressing myths and misconceptions. From concerns that contraception causes infertility to worrying that a LARC could get lost inside of a woman’s body, women shared deep fears of real or perceived side effects as a major barrier to women’s use of modern family planning methods, with the intrauterine device (IUD) often cited as the least trusted method. To improve consumer perceptions for LARC, PSI Cambodia developed social behavior change campaigns across digital platforms, mass media channels and through interpersonal communication (IPC) to counter the myths and misperceptions standing between women and their ability making the health choices that shape their lives. As WHP research found, the efforts have improved women’s perceptions of IUDs; the percentage of women who agree or strongly agree with the statement “an IUD is an effective contraceptive method for women like me” increased from 75 percent in 2013 to over 80 percent in both 2015 and 2017.
- Big Mama (or, mothers with five or more children). New Mama. Post-Abortion Women. When it comes to SRH needs, there isn’t a one size fits all. Identify where women are in their health journey and meet them there. Household mapping allowed us to define five population segments and refine our interventions accordingly. These included: 1) Big Mama, or traditional method users who attribute method failure to the method and not behavior; 2) New Mama, or women who don’t believe that they can get pregnant again until menstruation resumes (which isn’t the case); 3) Post-Abortion Women; 4) Traditional Method Users and 5) Interested Non-Users. Segmentation allowed us to develop stories that resonated with different groups, making them more inclined to hear and respond to messages received. And we tested reaching different segments in varying group sizes – opting for larger groups to generate awareness and smaller groups to change behaviors. The value of this work benefitted not only the women reached, but also the community-based mobilizers and IPC agents who, using a newly minted job aid, could easily customize their messaging to increase the productivity of their work. In fact, in 2015, the number of successful referrals per community mobilizer Interpersonal Communication agent increased to 142, up from 100 in 2014. Under WHP, PSI Cambodia supported over 250 private providers with trainings, job aids, and routine supportive supervision visits designed to improve counseling skills and service provision.
- Provider counseling plays a key role in a woman’s decision to use and/or continue a modern contraceptive method, especially the IUD. Client-centered counseling rooted in informed choice is essential to ensure that women understand the benefits, limitations and any potential side-effects associated with the method of their choice and that they are supported to choose and continue the method best suited to their needs, preferences and lifestyle. Particularly for methods like the IUD, where myths and misconceptions have been identified as barriers to use, counseling is essential to provide women with accurate information. Using a tailored, client-centered approach to counseling that ensures informed choice, amplifies the client’s voice, and places the client’s preferences and needs at the center (key tenets of PSI’s Counseling for Choice approach and tools), WHP-supported providers inserted 176,910 IUDs from 2008-2020.
- Providers who feel supported are best equipped to support consumers. We support providers to identify mechanisms for provider-initiated demand generation. The benefits are two-fold: we’re ensuring consumers have access to services, and that providers continually maintain the quality of their skills. Additionally, under WHP, we saw that when we provide ongoing support to providers, particularly in the unlikely occurrence of an adverse event, providers demonstrate increased motivation to continue offering services. We’ve since applied that learning in (and offer continued support through) PSI Cambodia’s Social Enterprise Fund.
For more, read the project learnings here.