Background
Setting
Staff | Management: 1 coordinator, 1 deputy coordinator, 1 youth coordinator. Support: 4 supervisors, 1 data officer, 1 finance officer, 1 part-time expatriate advisor (GTZ). Frontline: 36 nurse/midwives, 75 RHG facilitators, 14 youth/drama groups. |
Staff training
| Safe motherhood, FP, syndromic STI management, HIV prevention. |
Organisational development
| RHG management team was coached by GTZ in NGO internal governance issues, human resource management, project management, monitoring and evaluation, health information systems, survey design, implementation and evaluation. |
Supplies
| Contraceptives: oral, injectible, IUD, condoms, and spermicide supplied through health facilities. STI drugs: antibiotics for refugees from UNHCR, supplied through health facilities. Other: transport (2 pickups, 2 motorbikes), office and audio/visual equipment from GTZ. |
Funding
| Approximately USD 164,000 annually (1999). |
Partners
| GTZ (core funding, organisational development, technical assistance), ARC (training, funding some facilitators), UNHCR (refugee services coordination, reimbursement of Guinean health services for refugees), Guinean MoH (health facilities). |
Activities
| Health service based: Female refugee nurses and midwives, seconded to 28 Guinean health facilities used by refugees, provided services to refugees and Guineans. Community based: RHG facilitators provided information, contraceptives (condoms, spermicide) and referral. Theatre groups and youth clubs provided information and entertainment. |
Goal
| RH professionals and motivated community volunteers enabled to plan, provide and evaluate sexual and reproductive health services for their fellow refugees. |
Impact
| Improved RH service provision in Forest Region, increased contraceptive usage and STI prevention and treatment, and became an important actor in the health sector (RHG represented 'best practice' and 'worthy of study' – WHO consultant [16]). |
Objectives
Methods
Study design
Data collection
Data analysis
Results
Demographics
Variable | Category | Male (%) | Female (%) | X2p-value |
---|---|---|---|---|
All respondents:
|
445 (100)
|
444 (100)
| ||
Age | 15–19 | 103 (23) | 104 (23) | |
20–29 | 141 (32) | 189 (43) | ||
30–39 | 140 (31) | 118 (27) | ||
40–49 | 61 (14) | 33 (7) | 0.001 | |
Country of origin | Sierra Leone | 436 (98) | 432 (97) | |
Liberia | 7 (2) | 12 (3) | ||
Other | 2 (0) | 0 (0) | 0.19 | |
Arrival in camp | Before 1996 | 202 (45) | 188 (42) | |
1996 or later | 243 (55) | 256 (58) | 0.36 | |
Education | No formal education | 181 (41) | 316 (71) | |
Some formal education | 264 (59) | 128 (29) | <0.001 | |
Religion | Catholic | 82 (18) | 88 (20) | |
Protestant | 173 (39) | 184 (41) | ||
Muslim | 190 (43) | 172 (39) | 0.49 | |
Age at first penetrative sex | 15 years or less | 113 (25) | 228 (51) | |
16 years or older | 269 (61) | 185 (42) | ||
Unknown | 10 (2) | 5 (1) | ||
Never | 53 (12) | 26 (6) | <0.001 | |
Marital status | Never married | 170 (38) | 69 (16) | |
Currently married | 251 (56) | 320 (72) | <0.001 | |
Widowed/Separated | 24 (6) | 55 (12) | ||
Risk of unplanned pregnancy* | No | 141 (32) | 132 (30) | |
Yes | 304 (68) | 312 (70) | 0.53 | |
Ever married respondents
|
n = 275 (100)
|
n = 375 (100)
| ||
Polygyny | Respondent or husband has other wife/wives | 58 (21) | 120 (32) | 0.002 |
Residence of partner | Living together in camp | 237 (86) | 275 (73) | <0.001 |
Age at marriage+[29] | 10 or under | 0 (0) | 12 (3) | |
11–17 | 16 (6) | 265 (71) | ||
18–29 | 220 (80) | 96 (26) | ||
30+ | 39 (14) | 1 (0) | <0.001 | |
Female respondents
| -- |
n = 444 (100)
| ||
Parity | Nulliparous | -- | 84 (19) | |
Parous | -- | 360 (81) | -- | |
Parous female respondents
|
n = 360 (100)
| |||
Living children (women) | None | -- | 36 (10) | |
1–3 children living in household | -- | 258 (72) | ||
4–8 children living in household | -- | 66 (18) | -- |
Family planning
Variables | Category | Male (%) | Female (%) | X2p-value |
---|---|---|---|---|
a) Knowledge
| ||||
All respondents:
|
n = 445 (100)
|
n = 444 (100)
| ||
Can explain FP | Yes | 294 (66) | 389 (88) | |
Not sure | 151 (34) | 55 (12) | <0.001 | |
No. of FP methods known (excluding traditional methods) | None | 144 (32) | 132 (30) | |
1–2 methods | 241 (54) | 159 (36) | ||
3–5 methods | 60 (14) | 153 (34) | <0.001 | |
Methods identified w/o probing (multiple answers possible) | Condom | 269 (60) | 192 (43) | <0.001 |
Pill | 168 (38) | 272 (61) | <0.001 | |
Injection | 68 (15) | 206 (46) | <0.001 | |
Spermicide | 13 (3) | 85 (19) | <0.001 | |
IUD | 19 (4) | 77 (17) | <0.001 | |
Other (i.e. traditional methods) | 49 (11) | 77 (17) | 0.23 | |
Methods identified with probing (multiple answers possible) | Condom | 407 (91) | 404 (91) | 0.8 |
Pill | 321 (72) | 406 (91) | <0.001 | |
Injection | 250 (56) | 373 (84) | <0.001 | |
Spermicide | 100 (22) | 211 (48) | <0.001 | |
IUD | 110 (25) | 228 (51) | <0.001 | |
Respondents who explained FP
|
n = 294 (100)
|
n = 389 (100)
| ||
Key FP information source | RHG facilitators | 197 (67) | 262 (67) | |
Health workers | 55 (19) | 95 (24) | ||
Friends and family | 17 (6) | 20 (5) | ||
Drama groups | 14 (5) | 11 (3) | ||
Radio | 6 (2) | 0 (0) | ||
Other/Unknown | 5 (2) | 1 (0) | 0.006 | |
b) Attitude
|
Category
|
Male
|
Female
|
X
2
p-value
|
All respondents
|
n = 445 (100)
|
n = 444 (100)
| ||
Attitude to couples using FP | Approve | 326 (73) | 396 (89) | |
Disapprove | 95 (21) | 40 (9) | ||
Don't know | 24 (5) | 8 (2) | <0.001 | |
Attitude to RHG facilitators providing FP info | Approve | 334 (75) | 405 (91) | |
Disapprove | 91 (20) | 33 (7) | ||
Don't know | 20 (5) | 6 (2) | <0.001 | |
Attitude to FP teaching (to boys) | Before age 15 | 59 (13) | 84 (19) | |
Around age 15 | 155 (35) | 200 (45) | ||
Later than age 15 | 120 (27) | 102 (23) | ||
Disapprove/Don't know | 111 (25) | 58 (13) | <0.001 | |
Attitude to FP teaching (to girls) | Before age 15 | 158 (36) | 223 (50) | |
Around age 15 | 111 (25) | 117 (26) | ||
Later than age 15 | 66 (15) | 50 (11) | ||
Disapprove/Don't know | 110 (25) | 54 (12) | <0.001 | |
Respondents currently with partner
|
n = 251 (100)
|
n = 320 (100)
| ||
Partner's attitude to couples using FP | Partner approves | 163 (65) | 190 (59) | |
Partner disapproves | 60 (24) | 54 (17) | ||
Don't know partner's attitude | 28 (11) | 76 (24) | <0.001 | |
c) Practice
|
Category
|
Male
|
Female
|
X
2
p-value
|
All respondents
|
n = 445 (100)
|
n = 444 (100)
| ||
Reported use of contraception | Never | 260 (58) | 251 (57) | |
Past | 78 (18) | 77 (17) | ||
Current | 107 (24) | 116 (26) | 0.77 | |
Use by respondent/partner (multiple answers possible) | Ever used condoms | 164 (37) | 41 (9) | <0.001 |
Ever used pills | 71 (16) | 116 (26) | <0.001 | |
Ever used injections | 25 (6) | 70 (16) | <0.001 | |
Ever used spermicides | 12 (3) | 17 (4) | <0.001 | |
Ever used IUDs | 1 (0) | 5 (1) | <0.001 | |
Contraceptives currently used (multiple answers possible) | Condoms | 85 (19) | 14 (3) | <0.001 |
Pills | 32 (7) | 59 (13) | <0.001 | |
Injections | 12 (3) | 43 (10) | <0.001 | |
Spermicide | 0 (0) | 2 (0) | -- | |
IUD | 0 (0) | 0 (0) | -- | |
Respondents currently with partner
|
n = 251 (100)
|
n = 320 (100)
| ||
Discussion of FP with partner | Never | 108 (43) | 143 (45) | |
1–2 times in last 12 months | 68 (27) | 98 (30) | ||
More than twice in last 12 months | 75 (30) | 79 (25) | 0.35 | |
Current users
|
n= 107 (100)
|
n= 116 (100)
| ||
Where current users access FP | Health post/Clinic | 68 (64) | 106 (92) | |
RHG facilitators | 30 (28) | 5 (4) | ||
Any other locations | 9 (8) | 5 (4) | <0.001 | |
Why FP source was chosen (multiple answers) | Quality-more privacy | 84 (80) | 106 (91) | |
Quality-competent staff | 86 (82) | 97 (84) | ||
Quality-friendly staff | 82 (78) | 94 (81) | ||
Cost-cheaper | 75 (71) | 99 (85) | ||
Convenience-closer to home | 73 (70) | 71 (61) | ||
Quality-better product | 65 (62) | 75 (65) | ||
Convenience-shorter wait | 66 (63) | 71 (61) | ||
Quality-cleaner facility | 57 (54) | 67 (58) | ||
Convenience-use other services | 44 (42) | 80 (69) | ||
Quality-only available there | 41 (38) | 52 (45) | ||
Convenience-opening hours | 40 (38) | 46 (40) | ||
Convenience-closer to work/market | 28 (27) | 28 (24) | -- | |
Current non-users
|
n = 338 (100)
|
n = 328 (100)
| ||
Main reason for non-use of modern contraception | Fertility related* | 213 (63) | 261 (80) | |
Opposed to use | 82 (24) | 27 (8) | ||
Method related | 22 (6) | 32 (10) | ||
Provider related | 12 (4) | 7 (2) | ||
Lack of knowledge | 9 (3) | 1 (0) | <0.001 | |
Expected future contraceptive use | Never | 83 (25) | 45 (14) | |
Later/Don't know | 206 (61) | 240 (73) | ||
Within next 12 months | 49 (14) | 43 (13) | 0.001 | |
Current non-users, opposed to FP use
|
n = 82 (100)
|
n = 27 (100)
| ||
Religion opposed (all) | 45 (55) | 7 (26) | ||
(Muslim)
| 41(-) | 7(-) | ||
Respondent opposed | 22 (27) | 8 (30) | ||
Partner opposed | 12 (14) | 11 (41) | ||
Family opposed | 3 (4) | 1 (4) | 0.02 |