Family Planning: Fact or Fiction?

在这个项目中，我们想在乌干达的两个地区制作和评价关于计划生育的健康教育影片，每年，乌干达有数千名妇女和儿童因怀孕和分娩期间的问题而死亡。我们在2011-2015年的研究表明，这些死亡中约有20%可以通过使用避孕措施来避免意外怀孕。许多妇女在分娩后从未返回保健设施，但在她们分娩后仍在保健设施时，有一个重要的机会向她们提供避孕药具。虽然有几个项目培训保健工作者在分娩后立即提供避孕线圈，但在乌干达，很少有妇女带着计划生育方法回家。为了了解原因，我们的团队在2015年采访了乌干达的80名女性、男性和卫生工作者。我们发现，许多妇女希望有时间与丈夫讨论避孕问题（分娩时丈夫经常不在），并从分娩中恢复过来。女性担心出血等副作用，以及这些副作用对婚姻的影响;男性也担心副作用和管理这些副作用的成本。一些人相信恐怖的故事，例如线圈可以旅行到身体的其他部位或导致癌症。我们采访的许多人建议，需要进一步提高对计划生育的认识，成功使用计划生育的妇女应与其他人分享她们的经验。一些人建议男子陪同妻子到产前诊所（这在乌干达很少发生），与卫生工作者讨论未来的计划生育问题。虽然有关于计划生育的健康教育材料，但乌干达农村识字率低，这意味着书面材料不适合，但人们可以通过电影获得健康信息。以前曾制作过卫生教育纪录片和戏剧，但当地人民的参与很少。我们也不知道人们对纪录片（采访真实的人）和戏剧的反应会更好。在这个项目中，我们想测试在乌干达的两个地区，用两种不同的语言拍摄的健康教育电影是否可行，是否能为来自不同种族群体的人们所接受。在每个区域，我们将制作一个简短的（5分钟）纪录片和一个简短的戏剧。这些活动旨在消除一些最常见的避孕误区，鼓励男子与妻子一起至少参加一次产前诊所，并与卫生工作者讨论他们是否愿意在分娩后采取计划生育方法。我们将试图评估事实或虚构电影是否产生更大的影响。建立伙伴关系对这一项目的成功至关重要，因为它将非洲戏剧和电影方面的专家与社区保健和计划生育方面的专家以及行为改变干预方面的专家聚集在一起。我们将通过采访当地的乌干达男女来参与电影，并创造一个文化上合适的戏剧。我们将从不同的本地男性和女性焦点群体中收集对电影第一版、第二版和最终版的反馈，并将利用这个机会探讨他们对避孕的理解。每个版本都将根据他们的反馈进行编辑和改进。这就是所谓的“以人为本的方法”，在欧洲已被用于编制健康促进材料，但在非洲尚未采用。我们制作的健康教育影片可以在保健中心的候诊室、产前诊所、社区会议甚至电视上播放。将有可能在乌干达传播这些，并在更大的试验中测试其效果，看看看过这部电影的人是否更有可能在生育后使用计划生育。这是一个更广泛的工作方案的一部分，该方案已经通过培训乌干达的保健工作者来改善计划生育的提供。

In this project, we would like to develop and evaluate health education films on family planning in two areas of Uganda.Every year, thousands of women and children in Uganda die as a result of problems during pregnancy and childbirth. Our research in 2011-2015 showed that about 20% of these deaths could have been avoided by use of contraception, to prevent unwanted pregnancies. Many women never return to a health facility after giving birth, but there is a crucial opportunity to provide them with contraception while they are still at the health facility, after giving birth. Although several projects have trained health workers to provide the contraceptive coil immediately after delivery, few women go home with a method of family planning in Uganda. To understand why, our team interviewed 80 women, men and health workers in Uganda in 2015. We found that many women wanted time to discuss contraception with their husband (who was often absent at the time of delivery) and to recover from the birth. Women feared side-effects such as bleeding, and the impact these would have on their marriage; men were also concerned about side-effects and the cost of managing these. Several people believed scare stories, for example that the coil could travel to other parts of the body or cause cancer. Many people we interviewed suggested that more awareness-raising on family planning was needed, and that women who have successfully used family planning should share their experiences with others. Some people suggested that men should accompany their wives to antenatal clinics (which rarely happens in Uganda) to discuss future family planning with a health worker. Although health education materials exist on family planning, low levels of literacy in rural Uganda mean that written materials are not suitable, but people could access health information through films. Previous health education documentaries and dramas have been made, but with very little, if any, involvement of local people. We also do not know whether people would respond better to a documentary (with interviews of real people) or a drama. In this project, we would like to test whether health education films are feasible and acceptable to people from different ethnic groups, in two different languages, in two areas of Uganda. In each area, we will make one short (5 minute) documentary and one short drama. These will aim to dispel some of the commonest myths on contraception, to encourage men to attend at least one antenatal clinic with their wives, and to discuss with a health worker whether they would like a method of family planning after the delivery. We will seek to assess whether factual or fiction films make a more significant impact. A partnership is crucial to the success of this project, by bringing together experts in African theatre and film with experts in community health and family planning and experts in behavioural change interventions. We will involve local Ugandan men and women by interviewing them for the film, and creating a culturally appropriate drama. We will get feedback on the first, second and final versions of the film from different focus groups of local men and women, and will use this opportunity to explore their understanding of contraception. Each version will be edited and improved based on their feedback. This is called the "person-based approach" which has been used for developing health promotion materials in Europe, but not yet in Africa. The health education films we develop could be shown in health centre waiting rooms during antenatal clinics, in community meetings, and even on television. It would be possible to disseminate these in Uganda, and to test their effect in a larger trial, to see whether people who saw the film are more likely to use family planning after giving birth. This is part of a broader programme of work which is already improving provision of family planning by training health workers in Uganda.