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DKT Sudan Ensuring the Right for All to Quality Family Planning Options Since 2005

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DKT Sudan Ensuring the Right for All to Quality Family Planning Options Since 2005 DKT INTERNATIONAL DKT Sudan Ensuring the right for all to quality family planning options since 2005 mani ducks under gaps in the reproductive the thatched roof to health system through four Ahand her neighbor major initiatives: 1) policy this month’s cycle of oral advocacy, 2) community contraception. A village awareness, 3) training, and midwife, Amani recently 4) commodity security. attended a DKT Sudan training session, through After initiating activities in which she became a 2005, DKT recognized the community mobilizing agent. A midwife displays an IUD need to jump-start the stag- Thanks to new government at DKT’s franchised clinic in nant state of reproductive legislation which DKT sup- Gezira, where there is only one health and partnered with the reproductive health specialist ported, midwives now have for every 275,000 residents. Sudanese Ministry of Health the right to distribute the pill, (MoH) to do so. Building on a first step that DKT sees as the re-positioning its relationship with the MoH, DKT promoted of services provided by midwives. Previously programs that established post-abortion care employed as a birth attendant, Amani is now and family planning in public health clinics; a family planning expert in her community, developed protocols for family planning where she dispenses pills and guidance, and training for newly graduating doctors; and refers women to DKT facilities for long-term promoted policies that allow midwives to be contraception. Illiterate and lacking specialized involved in reproductive health services. In training, Amani and her family struggled to 2011, the MoH formally recognized DKT for get by on sporadic income from attending playing a pivotal role in reducing maternal deliveries; now, she is able to supplement her mortality. income with financial incentives received from DKT for sales and referrals. Amani credits DKT DKT has expanded the reach of family for improving the livelihood of her family as planning throughout Sudan by strengthening well as adding meaning to her profession. the capacity of remote rural clinics nationally and displaced-person camps in Darfur and the DKT is the largest non-governmental provider Eastern Front. DKT is addressing obstacles at of reproductive health products and services multiple levels: working with religious leaders in Sudan and provided over 1.3 million couple to promote community buy-in, promoting years protection (CYPs) there in 2011. This affordable commodities to the pharmaceutical accounts for 47% of all modern method market, and rehabilitating health facilities to users and translates to an estimated 260,000 improve their ability to serve more women with pregnancies averted. DKT Sudan addresses family planning services. (continued) Sudan spur the government to change policy. DKT was subsequently invited by the gov- In a developing world that is widely embracing ernment to sit on newly established commit- the benefits of contraception, Sudan, a conser- tees charged with increasing accessibility to vative Muslim nation, is still an exception. Only contraception and setting the national family 20% of women who wish to prevent pregnancy planning agenda. DKT promoted policies that have access to the means to do so, resulting in officially listed many forms of contraception a low modern contraceptive use rate of 5.7% as essential drugs, expanded accessibility, and high incidence (730 per 100,000 births) and substantially decreased the cost of birth of maternal mortality, the eighth highest control to consumers. globally. Compounding the problem is a situation in which over 30 million Sudanese DKT’s influence further contributed to are served by fewer than 35,000 healthcare systemic protocol shifts such as ensuring professionals, and only a very small fraction mandatory reproductive training for all of those are equipped to deliver reproductive graduating doctors and nurses, health health services. India, with its vast population, care providers who rarely received such has 50% more health care professionals per training previously. DKT played a key role capita than Sudan. in launching a mandate for family planning counseling following post abortion care and Religion and culture are highly intertwined in miscarriage cases. Evidence has shown that Sudan, and Imams, or Islamic religious leaders, women are significantly more likely to initiate hold a great deal of public influence. For contraception following such dialogue. many years, family planning was perceived to undermine a fundamental responsibility Empowering Midwives to conceive large families and was widely criticized by Imams. As a product of this social Village pressure, many Sudanese women experience midwives multiple, successive pregnancies without a (VMWs) are single menstrual cycle in the years following frequently marriage. Although steadily decreasing, Sudan’s the preferred maternal mortality rate is one of the highest or only globally while its infant mortality rate (81 per accessible Village midwives trained 1,000 live births) is more than ten times greater resource for as community mobilizers than Western countries. reproductive- display IUDs. 6,000 rural related issues women have been referred in rural areas, to DKT clinics through Policy Advocacy this program. where 80% of In 2007, in collaboration with the MoH, Sudan’s population resides. VMWs are DKT initiated an unprecedented national present for the more than three-quarters of family planning and post-abortion care deliveries that take place at home. Before conference, bringing together key opinion DKT’s lobbying efforts, legislation that would leaders to foment public discussion and allow their role to be expanded beyond just birth attendants had consistently been op- and take posed. Embracing UNFPA’s initiative to employ pro-birth midwives to address women’s unmet needs, spacing DKT engaged the midwifery workforce as messages community mobilizing agents in rural areas. to their local DKT has directly trained some 3,000 illiterate communi- VMWs to motivate rural women to consider ties. To date, long-term contraception. Midwives have some 700 been successful using these tactics, especially Imams have for women who can get to a clinic, where a attended A doctor and midwife field reproductive health questions large proportion of women now choose to workshops on DKT’s weekly radio show. have IUDs inserted while still on the delivery sponsored by table. DKT. Addressing consumers directly, DKT has taken to the airwaves, running an educational DKT-trained midwives influence rural women radio show that reaches 80,000 listeners to choose long-term contraception, like IUDs weekly and responds to questions about and implants. Through a referral card system, family planning from inquisitive callers all midwives receive financial incentives for over the country. each woman who follows through at a DKT-sponsored facility. In 2011, 6,000 new Transforming the Market women received services as a result of the program. In 2011, oral contraceptives and IUDs were DKT’s most widely sold products in Sudan, In 2012, DKT provided the commodities with sales of 365,000 cycles and 119,000 units, and resources to train Darfur VMWs in IUD respectively. Despite authorization for only insertion, the first time midwives have ever post-abortion use, Misoprostol and MVA been allowed such training. A few years ago, demand was also considerable in 2011, the prospect of midwives distributing the pill with sales of 450,000 pieces and 16,000 kits, seemed unimaginable. Today, midwives are respectively. Condoms are used in Sudan learning how to insert IUDs, preparing manual primarily for relations with sex workers, serving aspiration kits (MVAs), and leading workshops an important purpose in HIV/AIDS prevention. attended by religious leaders. In 2011, DKT sold over 925,000 condoms as the main distributor of condoms in the capital Community Awareness and the sole supplier in some states. DKT Sudan has engaged Imams to discuss the Prior to DKT’s 2005 entrance to Sudan, birth benefits of birth spacing, framing it as a practice control products were available exclusively that promotes improved health outcomes for at privately run clinics. IUDs were seen as mothers and infants. Through seminars where luxury products, typically selling at $100. DKT educates Imams, DKT is changing the DKT-supplied IUDs are now available at public attitudes of religious leaders, many of whom now speak on behalf of DKT to other Imams (continued) facilities at a cost of around $2-3 (complete is looking ahead toward bigger wins, such with the insertion service) to the patient, as national policy that would officially allow a price accessible to most women. Addition- midwives to insert implants and IUDs, and to ally, DKT is now the main supplier of IUDs contribute to post-abortion care by preparing and MVAs to the Planned Parenthood MVAs. Equipped with evidence from pilot proj- Federation of America (Sudan) and Ana ects and through its role in the Reproductive Assudan, established humanitarian NGOs Health Program Forum, DKT is in a position which use the materials in conflict areas to expand its influence on a large scale. like Darfur and East Sudan. Supporting reha- bilitation and training efforts, and providing DKT has been widely recognized as a major commodities at low prices, DKT is increasing influence on national protocols introduced these organizations’ capacity to serve more to require reproductive health training for and more women with higher quality care. graduating doctors, family planning counseling following all post-abortion care, and maternal Social Franchising health centers in public facilities. It is in large part due to these systemic changes that health DKT Sudan’s MotherHealth-branded franchise outcomes like the maternal mortality rate is network actively collaborates with government falling and contraceptive prevalence is on the hospitals. The franchised clinics (inside or upswing. DKT plays a crucial role in increasing attached to hospitals) feature DKT signage availability and use of low-cost contraceptives, and are visited regularly by DKT staff to expanding the number of general medical ensure product availability.
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