On the Drawing Board: Honing Family Planning Interventions Before Scale-Up in Two Countries

Young first-time mothers (FTMs; ages 15-24) are most vulnerable to closely-spaced pregnancies and adverse outcomes for themselves and their newborns. The transition to parenthood provides opportunities to improve FTMs’ use of health services, including voluntary postpartum family planning (PPFP). However, many existing efforts have involved complex interventions that prove challenging to scale and sustain. The Connect project sought to develop sustainable FTM interventions by “enhancing” USAID projects in Bangladesh and Tanzania, embedding light-touch interventions targeting barriers to FTMs’ PPFP use into those projects’ activities. Interventions combine home visits led by community health workers (CHWs) with efforts to improve quality and responsiveness of facility services.

We used collaborating, learning, and adapting (CLA) approaches in small-scale testing to improve feasibility, acceptability, effectiveness, and scalability of the interventions and to inform strategic decision-making about scale-up. Following formative research and design processes, we developed preliminary theories of change underpinning implementation and evaluation efforts. Through pause-and-reflect meetings with CHWs and facility providers, “pulse check” sessions with FTMs and family members, using monitoring for learning, and consultation with health system stakeholders, we identified needed adjustments to tools and implementation approaches, and documented insights to inform scale-up. Rapid surveys assessed effectiveness and acceptability to FTMs. CLA efforts proactively informed the identification of challenges and gaps to be addressed, collaborative scenario planning prior to scale-up, and strategic decision-making. We identified significant improvements in PPFP uptake among FTMs, and other outcomes of interest (couple communication, self-efficacy). We continue to apply CLA to further improve interventions during wider-scale implementation through internal and external collaboration.