Разом до Здоров’я фінансується Агенством США з Міжнародного Розвитку та впроваджується корпорацією Інститут Дослідництва та Тренінгів JSI у співробітництві з Академією Сприяння Освіті та Школою Громадського Здоров’я Гарвардського Університету Baseline Assessments in Dnipropetrovsk, Odessa, Poltava, Vinnytsa and Volyn Oblasts 2007 Tymoshevska Viktoriya, M&E Coordinator, “Together for Health” project

Baseline Assessment (BL) Objectives To document the initial status of family planning/reproductive health (FP/RH) in five oblasts – Dnipropetrovsk, Odessa, Poltava, Vinnytsa and Volyn - specifically regarding: –Attitudes of women of reproductive age (WRA) and health providers toward FP methods; –Practices of WRA (use of services and contraceptives); –Practices of providers (counseling on FP/RH), as reported by WRA and by providers; –Availability of IEC materials and contraceptives in health facilities and pharmacies; To identify areas that need improvement.

Baseline Assessment Methodology Timeline:  Dnipropetrovsk – July 2007  Odessa - November 2007  Poltava – May 2007  Volyn oblast – April 2007  Vinnytsa – June 2007 Randomly selected health facilities that provide FP/RH services Healthcare facilities: inpatient and outpatient; Clients (WRA) not being treated for infertility or infertile; Pharmacies: private and public; Health providers: ob-gyns, nurses and midwives who work in health facilities that provide FP/RH services.

Baseline Sample Characteristics DniproOdessaPoltavaVinnytsaVolynOverall Clients interviewed ,646 Health Facilities Assessed Pharmacies Assessed Providers interviewed

Respondents’ (WRA) Characteristics Oblast Mean age Marital Status Married or in union SingleDivorced or widowed Dnipropetrovsk2976.8%11.6%9.5% Odessa2880.7%10.5%7.2% Poltava2977.1%12.5%7.3% Vinnytsa2884.4%9.4%5.0% Volyn2779.1%14.2%3.0%

Purpose of Visit to Health Facility Oblast Consul- tation Annual check- up F/U visit FP services AbortionDeliveryAntenatal care Dnipro- petrovsk 25%29%11%7%9%6%14% Odessa30%15%12%10% 7%17% Poltava27%20%6%10%7%8%22% Vinnytsa30%10%4%6%2%24%23% Volyn27%21%9%5%1%14%23%

Attitudes of Clients & Providers to Contraception

WRA with Positive Attitudes toward Contraception: Condoms, IUDs, COCs

WRA with Positive Attitudes toward Contraception: Injectables, LAM, EC

Health Providers with Positive Attitudes toward Contraception: Condoms, IUDs, COCs

Health Providers with Positive Attitudes toward Contraception: Injectables, LAM, EC

Clients’ Practices: Use of Contraception

Contraceptive Use among Respondents WRA leaving health facilities

Contraceptive Use among Respondents, Dnipropetrovsk Oblast WRA leaving health facilities

Contraceptive Use among Respondents, Odessa Oblast WRA leaving health facilities

Contraceptive Use among Respondents, Poltava Oblast WRA leaving health facilities

Contraceptive Use among Respondents, Vinnytsa Oblast WRA leaving health facilities

Contraceptive Use among Respondents, Volyn Oblast WRA leaving health facilities

Providers’ Practices: FP/RH Counseling and Services

WRA Reporting Receiving Key Information during FP Counseling

WRA Reporting Receiving Counseling on 3 out of 5 Key FP Topics

WRA Reporting Receiving Counseling on Key STI Topics

WRA Reporting Receiving Counseling on 2 out of 3 Key STI Topics

WRA Assessments of Health Providers’ Practices

WRA Perceptions of Services at Health Facilities

Health Providers’ Self-Reported FP Counseling Practices

Health Providers’ Self-Reported Counseling on 3 out of 5 Key FP Topics

Health Providers Self-Reported STI Counseling Practices

Health Providers’ Self-Reported Counseling on 2 out of 3 Key STI Topics

Availability of Contraceptive Methods/ Brands in Health Facilities and Pharmacies

Availability of any Free FP Method in Health Facilities

Availability of Free COCs in Health Facilities

Availability of Free Condoms in Health Facilities

Availability of Free IUDs in Health Facilities

Availability of Selected COC Brands in Pharmacies at Average Price BELOW 30 UAH Product average prices in UAH are indicated under the brand names.

Availability of Selected COC Brands in Pharmacies at Average Price ABOVE 30 UAH

Availability of other Hormonal Contraceptive Brands in Pharmacies

Availability of IUDs and Condoms in Pharmacies

Availability of Informational/Educational (IEC) Materials in Health Facilities and Pharmacies

Availability of non-TfH IEC Materials on FP/RH in Health Facilities Posters on FPBrochures about FP Almost all IEC materials promote specific brands

Availability of (non-TfH) IEC Materials on FP/RH in Pharmacies Posters on FPBrochures on FP

Conclusions & Implications

About the Study Sample sizes and characteristics of the respondents were very similar across all five oblasts. Clients (WRA) Average age was 27-29; Marital status – either married or in union (>75% of all respondents); Main reasons for visiting the health facility were: –Consultation –Annual check-up –Antenatal care; Abortion and FP services comprised almost equal proportions of the reasons women visited health facilities—and was around 7%

About the Study Health Facilities: Approximately 50% of all health facilities surveyed in all oblasts were in-patient (e.g. maternities, ob/gyn departments) and the rest were outpatient (e.g. women consultations, FP centers); On average each health facility had 5-8 ob-gyns, 7-10 midwives, 2 feldshers; Health Providers: The majority of respondents where either ob-gyns or midwives; in a few cases they were nurses and feldshers; On average, 3-5 health providers per health facility were asked to fill in the self-administered questionnaire; Pharmacies: Over 70% of all assessed pharmacies were privately-owned and belonged to a chain; One-third of pharmacies were located in the health facility that was assessed; the rest were located meters from the health facility; Each pharmacy had 1-2 provisors, 2 pharmacists and 1 sales person;

Attitudes toward FP Methods The attitudes of WRA toward modern contraceptive methods were similar across all five oblasts: over 60% had a positive attitude toward condoms, IUDs and COCs (the three most widely used modern FP methods)—but there is still much work to be done; Attitudes toward injectables and emergency contraception (EC) are quite negative: on average only 17% of WRA have positive attitudes toward EC and about 12% towards injectables; Health providers have more positive attitudes to FP methods than WRA and, by providing quality FP counseling, have an opportunity to change attitudes of WRA and break existing barriers;

Contraceptive Use (I) Contraceptive use varied across oblasts: Use of modern methods differed substantially between the oblasts: –Highest use rate was in Dnipropetrovsk - 50% of respondents; –Lowest use rate was in Vinnytsa – 28%; –Odessa, Poltava and Volyn ranged from 30 to 40%; Use of traditional methods was similar across oblasts – 7-8% (except Vinnytsa 4%); The percentage of non-users ranged from 43% in Dnipropetrovsk to 68% in Vinnytsa;

Contraceptive Use (II) The method mix was very similar across all oblasts: –Condom use was around 20% (from 26% in Dnipropetrovsk to 14% in Poltava); –Use of COCs ranged from 8% in Volyn to 13% in Odessa; –Lowest IUD use was in Odessa, Vinnytsa and Volyn--5%-6%; highest was in Dnipropetrovsk and Poltava--10%-11%; –EC and spermicides were rarely used, according to respondents: Only 3% of respondents across all oblasts used spermicides; Only 1% used EC in Dnipropetrovsk, Odessa and Volyn;

Contraceptive Use (III) It is unclear why modern contraceptive use patterns are so different across the oblasts; WRA still rely on only a few modern contraceptive methods: IUDs, condoms and COCs; Women need more information about the range of modern methods, their risks and benefits so they can make informed decision about which method they will be using.

Women reported that about 70% of health providers in all oblasts cover at least 3 out of 5 key topics during FP counseling (except Volyn – 54%); Women reported that two thirds of health providers across the oblasts cover 2 out of 3 key topics in STI counseling (except Volyn – 55%); Some oblasts need to improve the quality of FP/RH and STI counseling; FP and STI Counseling (I)

FP and STI Counseling (II) Health providers state that they provide more information than is reported by the women: –On average 85% of health providers across the oblasts state that they always mention at least 3 out of 5 key FP topics; –And 75% of health providers in all oblasts state that they always mention at least 2 out of 3 key STI topics;

Overall, availability of free FP methods was low: –Highest in Dnipropetrovsk - 64% of health facilities; –Lowest in Poltava and Vinnytsa - 14% of health facilities; Free COCs were available in 32% of health facilities in Dnipropetrovsk but only 5% in Odessa and Poltava; Free IUDs were available in all oblasts, ranging from Dnipropetrovsk – 50% to Poltava - 10%; Male condoms were available in 32% of health facilities in Volyn, 14% in Odessa and Vinnytsa, and 9% in Dnipropetrovsk; More efforts should be made to improve availability of free contraceptives for eligible clients. Availability of Free FP Methods in Health Facilities

Availability of COCs costing under 30 UAH in pharmacies varied considerably across the oblasts: –Cilest was available on average in 12% of surveyed pharmacies (except Volyn - 0%); –Regulon and Rigevidon were the most widely available affordable brands: about 65% of pharmacies across all oblasts; Availability of COCs costing above 30 UAH was similar for most of the brands (except Yarina and Mercilon) Availability of Depo-Provera ranged from 25% of pharmacies in Odessa to 6% in Vinnytsa; Availability of the progestin-only pill Exluton was highest in Dnipropetrovsk – 16% and very low in Poltava, Vinnytsa and Volyn – 3%; Availability of FP Methods in Pharmacies (I)

Availability of FP Methods in Pharmacies (II) Availability of IUDs ranged from 10% for Pregna to 30% for Multiload, Junona and Nova- T across the oblasts; Results of assessments suggest further efforts are needed to: –Improve the availability of affordable brands of COCs; –Improve the availability of an expanded range of methods (injectable and progestin-only pill).

Availability of IEC materials on FP methods (not TfH materials) in health facilities was satisfactory in all oblasts: –Over 70% of health facilities had posters about FP (except Volyn-- 59%); –Over 80% of health facilities in Dnipropetrovsk, Poltava and Vinnytsa had brochures about FP methods; and about 60% in Odessa and Volyn Oblasts; Availability of IEC materials (not TfH materials) in pharmacies was low in all oblasts: –Less than 30% had a poster on FP methods (except Poltava--42%); –Less than 30% had a brochure on FP methods (except Dnipropetrovsk – 40%); IEC materials almost always promoted specific brands, pointing to the need for unbiased information about a broad range of FP methods. Availability of IEC materials

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