Academic journal article International Perspectives on Sexual and Reproductive Health

Integrating Family Planning Promotion into the Work of Environmental Volunteers: A Population, Health and Environment Initiative in Kenya

Academic journal article International Perspectives on Sexual and Reproductive Health

Integrating Family Planning Promotion into the Work of Environmental Volunteers: A Population, Health and Environment Initiative in Kenya

Article excerpt

Voluntary use of family planning is instrumental to the health and social well-being of women, families and communities. (1,2) Although contraceptive use in Sub-Saharan Africa is increasing, (3) unmet need for family planning remains high. (4) Even within countries that have achieved increases in contraceptive prevalence, use remains low among some population subgroups. Contraceptive prevalence is generally lower in rural areas than in cities, and is consistently lower among women in the lowest wealth quintile than among those in the highest. (5) Achieving progress in health and social indicators, such as those captured by the Millennium Development Goals, depends on expanding family planning services to poor, remote rural areas in Africa. (6)

One promising approach for promoting family planning use within traditionally hard-to-reach populations is to integrate services with those of other development sectors. (7) Integrating messages and services from different sectors offers several potential advantages over traditional, single-sector development programs. For example, in the field of population, health and environment (PHE), (8,9) family planning and other health services are linked with environmental conservation initiatives, which gives environmental programs an opportunity to educate communities about the relationship between rapid population growth and environmental degradation. Further, by facilitating access to family planning services and publicizing their role in preventing unplanned pregnancies, environmental programs can offer a practical, immediate action that contributes to future conservation of natural resources. Meanwhile, the PHE approach offers family planning programs arguments beyond those related to health benefits to use when encouraging couples to plan pregnancies and consider contraceptive use. Women and men may be motivated by messages highlighting the associations of family size with household prosperity and the availability of such natural resources as firewood, water, and land for cultivation and grazing. (10) From a program management perspective, integration may improve efficiency, because multiple activities and services can be carried out by the same workers within a single management structure. Finally, integrated programs can target broader audiences. Some people may be drawn into conservation efforts through an interest in family planning education; others may be engaged in environmental initiatives, but then benefit from increased access to family planning education and services. (11)

Although the potential advantages of linked population and environment programs are increasingly acknowledged, (12,13) evidence is still limited regarding the feasibility and acceptability of PHE initiatives. (7,14) In some of the best known PHE models, such as those implemented in the Philippines (10) and Madagascar, (15) health promotion was added to environmental initiatives through the intervention of community health workers. Less is known about the ability of environmental workers to assume a direct role in health promotion. To help fill this evidence gap, the Program Research for Strengthening Services (PROGRESS) project, which was funded by the U.S. Agency for International Development to improve access to family planning services, teamed with the Green Belt Movement (GBM), a Kenyan nongovernmental organization dedicated to environmental conservation and community development. Leadership at both PROGRESS and GBM recognized that the latter organization's community-based environmental initiative complemented the former's efforts to expand family planning services to remote areas. Unknown was whether GBM's frontline environmental outreach workers, known as Green Volunteers, could lead family planning promotion activities. Of particular interest was whether these volunteers, many of whom are semiliterate and have no health training, would be willing to take on added responsibility and whether they could master PHE concepts sufficiently well to convey related information to the community. …

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