1. Imarisha Maisha Promoting Family Planning among Persons with Disability in Urban Kenya Author: Mercy Kamau Co-Authors: Margaret Kilonzo, Jane Otai, Kenneth Owino, and Morine Lucy Sirera International SBCC Summit 2016 February 8–10 Addis Ababa, Ethiopia

2. Outline  Background  Why family planning (FP) for people with disability (PWDs)?  Tupange Project  Intervention objectives  Program intervention  Data collection  Results  Lessons learned  Recommendations  Acknowledgments  References 2

3. Background 3  PWDs have a condition that restricts their mental, sensory, or mobility functions to perform a task the same way as a person without a disability.  PWDs make up 10% of the world’s population.  PWDs have sexual and reproductive health (SRH) needs like anyone else does.  PWDs face barriers to SRH services (WHO and UNFPA 2009).

4. Why FP for PWDs? 4  In Kenya, 58% of married women in the general population use FP (KNBS et al. 2015), but only 15.6% of married women with disability do (NCAPD and KNBS 2008).  Tupange aimed to reach urban poor populations including PWDs, but community health volunteers (CHVs) were largely unable to reach PWDs due to social and communication barriers.

5. Tupange Project  Funder: Bill & Melinda Gates Foundation  Goal: To increase contraceptive prevalence rate by 20%, especially among the urban poor  Period: 2010–2015  Focus cities: Kisumu, Nairobi, and Mombasa  Scale-up cities: Kakamega and Machakos 5

6. Intervention Objectives  To increase access to FP services among PWDs  To address health facility barriers hindering SRH services for PWDs 6

7. Program Intervention  Piloted in Kibera, an informal settlement, between April and December 2014  Implemented within the Ministry of Health (MOH) community strategy  Leveraged three existing groups for PWDs; the groups held monthly meetings, providing a good forum to reach PWDs with FP services  Sourced transport, especially for clients in wheelchairs 7

8. Program Intervention (cont.)  Oriented service providers on the new initiative for PWDs  Provided feedback during the CHVs’ monthly meeting and follow-up visits by MOH officers  Identified a CHV with visual impairment and trained her on FP, based on MOH criteria  Paired the CHV with a sign language translator to reach out to people with hearing impairments  Linked the CHV and the translator to an MOH health facility 8

9. Program Intervention (cont.)  The CHV and the translator provided FP information and birth control pills and conducted referrals, as needed, for PWDs  Whenever required, the CHV and the translator accompanied the clients to the health facility 9

10. Data Collection  Data collected during the CHVs’ monthly meeting through:  CHVs commodity tracking tool  Referral booklets  Testimonies during the CHVs’ monthly meetings 10

11. Results 11  More than 180 PWDs and caregivers were reached with FP information  81 PWDs received FP methods  42 pills  28 Depo-Provera®  9 implants  1 intrauterine contraceptive device  1 bilateral tubal ligation

12. Lessons Learned 12  The approach is sustainable if existing resource contacts for PWDs are trained and incorporated in the MOH community strategy  The intervention is simple and easy to scale up in other areas to accelerate FP uptake among PWDs

13. Recommendations 13  Reproductive health programs need to include effective strategies for reaching out to PWDs  Tupange’s project experience can be replicated elsewhere to provide FP services to PWDs

14. Acknowledgments 14  Bill & Melinda Gates Foundation  Jhpiego  MOH, Kenya  CHVs of Kibera

15. Thank You Simple and local solutions for social and behavior change communication for health 15

16. References  KNBS et al. 2015. Kenya Demographic and Health Survey 2014. Nairobi, Kenya: KNBS. http://dhsprogram.com/pubs/pdf/FR308/FR308.pdf. http://dhsprogram.com/pubs/pdf/FR308/FR308.pdf  NCAPD, KNBS. 2008. Kenya National Survey for Persons with Disabilities: Main Report. Nairobi, Kenya: NCAPD. http://statistics.knbs.or.ke/nada/index.php/catalog/35/dow nload/182. http://statistics.knbs.or.ke/nada/index.php/catalog/35/dow nload/182  WHO, UNFPA. 2009. Promoting Sexual and Reproductive Health for Persons with Disabilities: WHO/UNFPA Guidance Note. Geneva, Switzerland: WHO. http://www.unfpa.org/sites/default/files/pub- pdf/srh_for_disabilities.pdf. http://www.unfpa.org/sites/default/files/pub- pdf/srh_for_disabilities.pdf 16