Participatory Midterm Review of the Social Change for Family Planning Results Initiative

The goal of the four-year Results Initiative (RI) in Ethiopia, Kenya, and Rwanda is to increase and sustain family planning (FP) use through a combination of health system strengthening and strategies that address the social factors that influence health. A midterm review of the project was an opportunity to highlight social shifts that may be occurring as a result of the project while trying to better understand how these changes occur.

We adapted the Most Significant Change (MSC) methodology to qualitatively identify, within focus group discussions, the direct and indirect changes occurring in target areas, while providing an opportunity for reflection within the communities we work. Through MSC we were able to rank the community's perspective on what is happening in their communities as a result of the project. FGDs were triangulated across a range of informants.

An analysis of the results from the adapted methodology showed similar stories of significance across the three projects. We documented increased couple communication about FP and sexuality. More couples are sharing household tasks and decision-making about economics and FP. More couples are seeking FP and VCT services together and community members reported increased confidence and self-efficacy in challenging social norms.

Adapting the MSC methodology allowed us to take a snapshot of community perceptions of the significant changes they are seeing in their community without pre-defining what we think the changes are. The tool was effective at fostering reflective discussion amongst FGDs. Participatory analysis and discussion with project staff offered a level of validation.