By Kate Whitener, Knowledge Management and Communications Fellow, PSI Cambodia, Kayla Mardin, Program Coordinator, LAC, Emma Halper, Associate Program Manager, LAC/Asia and Yarat Un, External Relations and CC Manager, PSI Cambodia
In rural communities of Cambodia information related to family planning and reproductive health is difficult to access. The information shared, particularly when it is not spread by health workers, often perpetuates myths and stigmas. Inaccurate information often comes from long-standing beliefs in rural communities that modern family planning methods make women who use them infertile for life. As a result, Cambodia has recently seen a rise in the use of traditional contraceptive methods, especially withdrawal. And although Cambodia’s maternal mortality rate has decreased over the years, it remains a problem in the countryside where access to health services is often difficult and requires clients to travel long distances.
The PSI-led Promoting Healthy Behaviors (PHB) program has modeled its family planning intervention off of a previous PSI initiative that took place in Cambodia’s Pursat province. PHB is a five-year project funded by USAID to improve healthy behaviors among Cambodians and ensure that they seek and receive quality healthcare with decreased financial hardship. Working with its government and NGO partners, PHB implements social and behavior change (SBC) activities addressing six health areas, including tuberculosis, maternal and child health, family planning, malaria, nutrition and water, sanitation, and hygiene. In Kampong Chhnang province, PHB is collaborating with the Ministry of Health and a local NGO, Partners in Compassion (PC), to design and lead the intervention together, working closely with local community members.
In December 2019, the PHB team met with people from various rural villages in Kampong Chhnang to gather information about behaviors, fears, motivations, and overall attitudes about family planning. In the village of Prey Khmer, the PHB team met with community members to discuss family planning methods in a way that was both meaningful and relatable to them while fostering an environment that made it easy for the couples to talk about different family planning methods without fear of judgement or discrimination.
A number of key insights came from these activities, including the critical role played by men in decisions around family planning, the lack of communication between couples on key issues such as when and how many children to have, and a number of important misconceptions related to side effects of modern contraceptive methods. Based on these and other insights, the PHB team adapted existing tools and developed prototypes of various new communication tools and strategies, all in Khmer, aimed to address the various barriers and motivators to modern contraceptive use among couples.
For example, The Loving Relationships Booklet was designed to encourage couples’ communication about what makes a healthy relationship and partnership. Once developed, the booklet was tested in small groups comprised of couples that weren’t using any modern methods and a small women’s group, with the encouragement and support the village elders and leaders. The sessions with couples were small, consisting of only four or five couples from a particular village and within the span of an hour participants tested and provided feedback on both the Loving Relationships Booklet and a second tool, the “Rumor” and “Real” Trivia Game. The small group size combined with the use of lighthearted and interactive games helped create space for dialogue where participants felt comfortable to share their opinions and experiences. The participants in the different groups were able to help the PHB team narrow down the most effective tools because they gave valuable and direct feedback and insight about what they liked and didn’t like about the tools, and what they found to be effective and culturally relevant. One young woman attending the demonstration session pointed out several images in the Loving Relationship Booklet that were confusing or culturally inappropriate; others helped the team see the value in orienting the booklet to married couples. Many men and women also stated how important it was to see actual examples of the different contraceptive methods as opposed to pictures or images, something they had never seen before, and to have all this information in their native Khmer language, as opposed to in English which had often been the case previously. These insights and feedback were instrumental in providing the team with the information necessary to adapt and localize the Loving Relationships Booklet and other tools and strategies.
The tools were designed to be simple but effective at disseminating information. Additional tools which community members responded very well to included:
- The Fortune Teller Game – a simple, entertaining game that gives couples facts and dispels common myths about the different modern methods.
- Beat the Goalie Game – a simple and fun game to engage with men and discuss with them the benefits/side effects of modern methods.
- A yellow card sleeve with a PHB designed cover designed to help promote postpartum uptake of modern contraceptive methods. It is included with newborn babies’ vaccine appointments.
The resulting social and behavior change materials, developed with and by rural Cambodian women and men in a safe and open environment, are now being used by health workers and communications agents in the villages of Kampong Chhnang. These social and behavior change activities help couples make the best family planning decision for themselves and their families.
