There is still much that needs to be done to secure good reproductive health for people living in Khyber Pakhtunkhwa. Maternal, infant and child mortality rates are high and there is a sizeable gap between women’s wanted and observed fertility. In particular, improvements are held back by a widespread reluctance to access existing services and other negative health outcomes associated with and stemming from the unequal status of women and girls. Conventional medically-oriented education and information campaigns have often been perceived as intrusive and culturally insensitive. As a consequence, there has been limited success addressing these key issues. Some of the insufficiencies of current community practices regarding reproductive health are highlighted by the high total fertility rate (3.9), low contraceptive prevalence rate (28% currently using) and little awareness concerning safe motherhood and family planning (Source)
The community dialogues planned for Nowshera and Haripur are an adaptation of the Generation Dialogue approach that has been implemented in the Yemen and various countries in Africa. In contrast to conventional Information, Education and Communication campaigns, this approach avoids promoting a series of generic reproductive health “messages”. Instead, men and women from different generations are brought together to think about current social practices and discuss their hopes and concerns regarding the future development of their community. The Generation Dialogue seeks to be respectful of the local context and rejects the notion that traditional practices are somehow backward or intrinsically harmful.
The challenge with education and medical information campaigns for issues such as reproductive health is that they are often perceived as intrusive and insensitive, limiting their effect. The community dialogues work in partnership with the local population, empowering communities to participate in a facilitated process of reflection about current practices and envisioning of possible changes. The different segments of the community (young and older women, young and older men, religious leaders, health workers) are treated as experts on their particular situation. Trained change agents, representing both sexes as well as the older and the younger generation, facilitate among their different peer groups respectful, yet open discussions and dialogues. For the breaking of silence around taboo issues concerning for example gender relations and sexuality, the Community Dialogues allow for the past and present circumstances and needs to be considered, values and beliefs to be discussed, and, gradually, possible strategies to deal with perceived problems and dilemmas brought forward and explored.
The overall objective is to increase awareness about Sexual, Reproductive and Health Rights in 2 districts of Khyber Pakhtunkhwa. To achieve this goal, a combination of 4 activities is being proposed that would run simultaneously and would complement each other in contributing to the achievement of RMNHP’s Results Area B. Similarly, the following 4 activities are in accordance with the Population Welfare Department KPK’s Population Policy.
- Two communities in Nowshera: Manki Sharif, Tarru Jabba and Kabul River
- Two communities in Haripur: Jatti Pind, Hattar and City 4
German Cooperation Deutsche Zusammenarbeit (GIZ)
- Generation Dialogues For reproductive health & rights
- Green Ribbon Campaigns
- Daikho, Bolo, Roko
- Most Significant Change Stories:
1. Generation Dialogues For reproductive health & rights
The overall aim of this activity is to increase awareness and uptake of reproductive health care in a way that is respectful and sensitive to the traditional local context by initiating a series of facilitated community dialogues in Districts Nowshera and Haripur, The dialogues have three main objectives:
- To improve inter-generational relationships and communication
- To identify values and traditions that are integral to a shared sense of community identity and that the younger and older generations cherish and want to uphold
- To identify social practices that have harmful effects on the reproductive health and rights of women and young people and to create an opportunity for the community to take steps to modify or, where necessary, abandon these practices
Although this may be a slow process, and the proposed changes initially small, the results are more likely to be sustainable and there will be a clear sense of ownership amongst the communities involved.
In this activity Community Consultations will be held to involve as many community members as possible in the Generation Dialogue process following the generation dialogue manual of GIZ. The trained trainers will carry out the generation dialogue through facilitators from each community (4 communities). A total of 32 facilitators be trained (16 for Haripur and 16 for Nowshera) to carry out the generation dialogue using the listen and learn method. Each facilitator will reach out at least 32 community members through the generation dialogue. This activity explores what men and women, young and old, think about the issues.
2. Green Ribbon Campaigns
This activity will involve trainers who will deliver key messages to the parents on parenthood particularly to fathers on fatherhood. It will encourage the sense of sharing among fathers and to be fathers about responsible parenthood specially focusing SRHR.
Trainers will be trained on inculcating messages among parents and to be parents / to be fathers about family planning and SRHR. The trainers will execute this activity alongside other trainings with the same participants. This will enhance the adherence of the participants from the community.
3. Daikho, Bolo, Roko
In this activity the already developed tool i.e. Daikho, Bolo, Roko by Rutgers against child marriages will be used to raise awareness among the community, members to highlight the relationship between child marriages and deterioration of reproductive health. It will highlight the compounding factors related to marriages that deteriorate a child’s reproductive and overall health situation.
For this activity to ensure the idea of “Dekho” key messages related to family planning and SRHR shall be developed and shared among parents and to be parents as well as among youth through social media, FM/radio channels, TV cable networks, SMS services of mobile networks and pledge cards. It will be ensured that every targeted member of the community notices the messages and understands the messages. Further the community will be involved “Bolo” in sharing their ideas , stance understanding on the issue in the light of the key messages they have received through blogs, round table conferences, replies on social media and text messages and signed pledge cards. Key notables figures such as religious leaders, teachers, town Nazim, doctors, quacks, midwives, and influential elders shall be invited to gatherings to share their stance and understanding on the issue to strengthen the attitude formation. In the last step i.e “Roko” to stop the inputs gathered from the bolo phase from key decision makers from the communities, Nazim, religious leaders, mid wives, traditional healers, bloggers, social media comments and the voice of the general community regarding the issues related to child marriages and usage of family planning services at institutional, service delivery and community and individual level shall be shared with the policy makers of the province through TV programs, round table meetings and one to one meetings province to advocate and lobby for the provision of family planning services to the community ensuring the implementation of law to end child marriages.
4. Most Significant Change Stories
MSCs have already been used as a significant tool to collect success stories on the effectiveness of basic life skill education on people’s life. This tool will be used to gather the stories of those community members who have are part of this project and have learned something that they will learn from these trainings and exercises. This can also prove to be an evaluation tool for this project to come up with success stories which can help in the further enhancement of the program.