Encouraging Family Planning Counseling that Promotes Meaningful Choice: Resource Package

"Behavioral design is an approach that leverages insights from behavioral economics, social psychology, human centered design, and other disciplines to develop and test innovative solutions that reshape people's environment to positively influence their behavior."

Formative research carried out by Breakthrough ACTION amongst postpartum women in Malawi indicated that providers often offer family planning (FP) counseling in a way that does not clearly convey the advantages and disadvantages of all methods and that may leave women feeling uncertain about whether specific methods are suitable for their unique needs. In response, Breakthrough ACTION collaborated with health workers, postpartum women, implementers, and policymakers in Malawi to develop a package of behaviourally informed, low-cost solutions that are designed to support providers in offering FP counseling in a way that promotes meaningful client choice.

The solution set consists of four FP counseling tools that are intended to be used together, though each one can be can be used as a standalone intervention. An accompanying guide highlights the "how-to" of the solutions so that implementers can consider if they may want to adapt them to their own settings. The guide includes more details and implementation considerations for each solution, downloadable files for each solution, and links to the formative research and evaluation results. Finally, a "handoff package" provides an overview of the solution set and is intended to encourage ownership and scale-up of the solution set by local partners in Malawi.

In July-August 2020, Breakthrough ACTION trained Health Surveillance Assistants (HSAs) to implement the solutions in communities in 10 facilities' catchment areas in Lilongwe and Machinga districts. They found that, from baseline to endline:

• The percentage of HSAs who reported giving women referrals to take up FP in the past 2 months increased significantly, by 34 percentage points (ppt).
• The percentage of HSAs who reported discussing FP method switching with women in the past 2 months increased significantly, by 62.7 ppt.
• The percentage of HSAs who said that women should always be able to switch their family planning method on the same day of their consultation increased significantly, by 36.4 ppt.
• The percentage of HSAs who knew that a woman is able to receive a FP method immediately after delivery (48 hours) increased significantly, by 34.1 ppt.
• HSAs' knowledge about when methods can be provided postpartum improved significantly by 65.2 ppt.

Overall, Breakthrough ACTION recommends that, to ensure successful implementation, implementing organisations work with Ministry of Health programme officers, providers, and facility supervisors to monitor the implementation's progress and the solutions' impacts on provider behaviour and client outcomes.