Guide to Organizing and Facilitating Usapan Final

iGuide to Organizing and Facilitating the Enhanced Usapan

ii Guide to Organizing and Facilitating the Enhanced Usapan

This Guide was made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents of this Guide are the sole responsibility of RTI International and do not necessarily reflect the views of USAID or the United States Government.

iiiGuide to Organizing and Facilitating the Enhanced Usapan

iv Guide to Organizing and Facilitating the Enhanced Usapan

vGuide to Organizing and Facilitating the Enhanced Usapan

Table of Contents

Acronyms .................................................................................................................................... vii

Acknowledgments ........................................................................................................................ ix

About This Guide ......................................................................................................................... xi

Introduction ................................................................................................................................... 1

Usapan: A Brief History ................................................................................................................. 1

Usapan: Purpose, Variants, and Requirements ............................................................................ 2

Purpose and Methodology ........................................................................................................ 2

Usapan Variants ........................................................................................................................ 2

Requirements ............................................................................................................................ 3

Steps in Organizing the Usapan Sessions .................................................................................... 3

Steps in facilitating the enhanced Usapan Sessions .................................................................... 5

Usapang Kuntento Na ............................................................................................................... 5

Usapang Pwede Pa ................................................................................................................... 8

Usapang Bagong Maginoo ...................................................................................................... 11

Usapang Buntis 1 .................................................................................................................... 14

Usapang Buntis 2 .................................................................................................................... 18

Usapang Batang Ina at Batang Ama (U-BIBA) ....................................................................... 22

ANNEXES ................................................................................................................................... 27

Annex A ...................................................................................................................................... 29

Annex B ...................................................................................................................................... 31

Annex C ...................................................................................................................................... 33

Annex D ...................................................................................................................................... 35

Annex E ...................................................................................................................................... 37

vi Guide to Organizing and Facilitating the Enhanced Usapan

viiGuide to Organizing and Facilitating the Enhanced Usapan

Acronyms ANC Antenatal Care BHS Barangay Health Station BHW Barangay Health Worker BTL Bilateral Tubal Ligation CHSR Community Health Service Record CHT Community Health Team CPR Contraceptive Prevalence Rate DOH Department of Health EBF Exclusive Breastfeeding EPI Expanded Program on Immunization FBD Facility-based Delivery FDS Family Development Sessions FP Family Planning FPAS Family Planning Action Session FP-CBT Family Planning Competency-based Training IMR Infant Mortality Rate IUD Intrauterine Device LAM Lactational Amenorrhea Method LARC Long-acting Reversible Contraceptive LAPM Long-acting Permanent Method M/WRA Men/Women of Reproductive Age MCH Maternal and Child Health MNCHN Maternal, Neonatal and Child Health and Nutrition NDHS National Demographic Health Survey NSV No Scalpel Vasectomy SBA Skilled Birth Attendance SDM Standard Days Method TCL Target Client List WRA Women of Reproductive Age

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Acknowledgments The Enhanced Usapan technical intervention and this guide would not have been possible without the enthusiastic support of the following LuzonHealth partners:

, for showing us, on the ground, the areas for improvement in the old Usapan;

Tarlac and Nueva Ecija, our laboratory sites for the enhanced Usapan; Bulacan and Batangas, early adopters with confirmed high conversion; Pangasinan, our laboratory site for U-BIBA; Pangasinan, Cagayan, Isabela, Benguet, Tarlac, Nueva Ecija, Bulacan,

Caloocan, Malabon, Valenzuela, Quezon City, Marikina, Pasig, Taguig, Cavite, Laguna, Batangas, Rizal, Quezon, Oriental Mindoro, and Albay, for contributing solid evidence that the enhanced Usapan works;

Department of Health (DOH) Regional Offices I, II, CAR, III, NCR, CaLaBaRZon, MiMaRoPa, and Bicol, for funding the facilitators’ trainings and roll-out of community sessions;

DOH Health Promotion and Communications Service, for endorsing the enhanced Usapan and integrating it in the Interpersonal Communication and Counseling (IPC/C) Training curriculum;

Commission on Population, for funding a series of nationwide enhanced Usapan facilitators’ training;

, FP Coordinator of DOHRO- CaLaBaRZon and , FP Coordinator of Rizal, for serving as external technical reviewers; and

All the community women and men who participated in our sessions.

We extend our sincerest thanks to all of you.

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xiGuide to Organizing and Facilitating the Enhanced Usapan

About This Guide

This manual provides information on how to prepare, organize, and facilitate the enhanced Usapan sessions. It is primarily for FP service providers (doctors, nurses, midwives, and barangay health workers) who are also doing demand generation. With the enhanced Usapan, they can readily meet the challenges of increasing FP uptake in local communities. They can facilitate more FP discussions, address the factors that contribute to unmet need, and combine demand generation and actual service provision on-site, whenever feasible. This manual has three major sections. The first gives a detailed description of the enhanced Usapan, including its purpose and methodology, and the requirements to run its sessions. It also presents the five variants. The second section provides guidance on how to organize Usapan sessions. It outlines the necessary preparatory steps: from identifying and inviting clients, selecting which Usapan variant to use, to preparing the venue and materials. It also provides guidance on how facilitators can prepare themselves to effectively run Usapan sessions. The third section walks the facilitators through the process of doing the enhanced Usapan variants, from registration to service provision or referral. In a step-by-step manner, it details the activities that need to be conducted and the key questions that that should be raised to encourage participants’ uptake of FP methods.

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Introduction

The implementation of the family planning (FP) program in the Philippines has been fraught with challenges. Among these are the limited contact between family planning service providers and non-users, the gap between FP information giving and actual FP service provision, and the stagnant rate of unmet need for FP. Data from the 2017 National Demographic Health Survey (NDHS) show that 83.3% of non-users neither discussed FP with a community health worker nor at a health facility. Moreover, even those who are reached by FP messages through mass media are not accessing FP services. While many health facilities conduct FP demand generation activities, service provision is sporadic and/or insufficient. These contribute to the high rate of unmet need for FP in the country, which hardly moved from 18% in 2013 to 17% in 2017. USAID, through its LuzonHealth Project with RTI International, has introduced a solution that directly responds to these challenges: the enhanced Usapan (conversation) sessions. The Usapan group communication technique was developed to link directly family planning service delivery with clients. Usapan uses education tools and counseling to (1) give women and men information on family planning services specific to their needs, (2) help them choose a method, and (3) provide them with the FP service they choose. These are all conducted on-site, in one session.

Usapan: A Brief History The idea of integrating immediate service provision with health education can be traced back to Save the Children’s “Family Planning Action Session” (FPAS) in 2001. Over the years, several USAID projects used this core concept and modified the group communication process for family planning. It was, however, the Public Sector Mobilization for Family Health Project 2 (PRISM2) in 2010 that came up with the Usapan brand and its four variants: Usapang Kuntento Na (for limiters), Usapang Pwede Pa (for spacers), Usapang Bagong Maginoo (for men) and Usapang Buntis (for pregnant women). To further improve upon Usapan and respond to specific lessons learned from PRISM2’s implementation, LuzonHealth developed an Enhanced Usapan in 2016. LuzonHealth has been implementing Usapan (PRISM2 version) since 2014 in 21 project sites. However, on average, only 11 percent of participants became family planning acceptors after these sessions. From field observations and service providers’ feedback, LuzonHealth identified the sources of inefficiency in the old Usapan. The main factor contributing to the low acceptance rate was information overload. Sessions were long (a minimum of two hours) with topics ranging from general benefits of family planning, fertility awareness, temporary family planning methods, permanent family planning methods, and gender violence. Facilitators follow a script that is based on the standard flip chart for family planning classes, using straight lecture as primary method to deliver the content. In the end, rather than helping couples choose a family planning method suitable to their needs, these sessions lead to indecision and deferment of action.

2 Guide to Organizing and Facilitating the Enhanced Usapan

In addition, participants within the sessions had differing family planning needs and so there was lack of focus in the discussions. While the Usapan technical guide emphasizes audience segmentation based on fertility intention, it does not discourage holding Usapan Combo (combination) that groups people with varying intentions all in the same session. The result is a discussion that integrates messages for limiters and spacers. LuzonHealth introduced an enhanced version of Usapan in July 2016, focusing on “motivational dialogue” rather than “information giving.” This enhanced Usapan lasts for about 30 minutes and is specifically directed towards helping participants choose a family planning method that fits their fertility intention. By the end of 2017, the Project demonstrated that the enhanced Usapan can produce a promising result of 70% conversion (percentage of acceptors from among the attendees). In 2018 the Project confirmed from wide-scale field implementation that conversion can reach 88%. This is, indeed, a long way from the old Usapan that yields only 11% acceptors.

Usapan: Purpose, Variants, and Requirements Purpose and Methodology Usapan primarily aims to provide simple information in a motivational manner to help clients choose a particular method according to his/her reproductive intention. It is conversational, with simple structured participatory exercises that build upon the clients’ knowledge and strengthens their resolve to practice FP. Participants of the Usapan are carefully screened: They are chosen according to their reproductive intentions, i.e., spacing the birth of their children or limiting their number. Each session should have a maximum of 15 participants.

Usapan Variants The enhanced Usapan has five variants for six distinct types of participants:

1. Usapang Kuntento Na (for limiters—those who wish to stop childbearing altogether)

2. Usapang Pwede Pa (for spacers—those who wish to postpone the next birth)

3. Usapang Bagong Maginoo (for male limiters—men who wish to stop childbearing altogether)

4. Usapang Buntis (for pregnant women)

a. Usapang Buntis 1. Women who are either on their first or second trimester and have

never received any antenatal care (ANC). The outputs of the session are birth plans and ANC check-ups.

b. Usapang Buntis 2. Women who are on their third trimester and have expressed a need for limiting or spacing postpartum. The outputs of the session are decisions on immediate postpartum FP methods and referrals to facility for delivery.


5. Usapang Batang Ina at Batang Ama or U-BIBA (for pregnant teens and teen parents—especially in areas with high incidence of teen pregnancy)

Requirements

These elements help ensure, to a large extent, the success of Usapan: 1. Participants. Each session should not have more than 15 participants (potential FP clients)

and not less than six participants. 2. Facilitators. At least three FP-Competency-based Training (FP-CBT) level 1-trained

midwives or nurses who can provide one-on-one counseling and administer FP methods on-site. A male facilitator for Usapang Bagong Maginoo. One Adolescent Job Aid (AJA)-trained midwife or nurse for Usapang BIBA.

3. Commodities. Temporary FP commodities (pill, condoms, SDM beads, injectables, implant,

IUD) for dispensing on-site. 4. Referrals. Make arrangements with referral hospitals or partner sites for the immediate

forthcoming schedule of bilateral tubal ligation (BTL) and/or no scalpel vasectomy (NSV), preferably within 10 days from the session. Referrals for adolescents should only be to hospitals ready to provide AY-friendly RH services (AJA-trained HSPs, audio-visual privacy, etc.)

5. Testimonials. Recruit a satisfied FP user from within the community of the participants.

She/he will talk briefly about how her/his personal/family life improved because of FP.

Steps in Organizing the Usapan Sessions

1. Identify clients. FP service providers can identify clients who have expressed need for birth spacing or limiting through records review. They can go over their target client lists (TCL), the Community Health Team (CHT) survey, Community Health Service Record (CHSR), their FP/Antenatal care-Expanded Program on Immunization (EPI) tools, and the barangay health workers’ (BHW) list of clients. 2. Decide which variant of Usapan you will conduct and remember the correct target

segment. - Pwede Pa for M/WRA with need for birth spacing - Kuntento Na for M/WRA with need for birth limiting - Bagong Maginoo for males with need for birth limiting - U-BIBA for pregnant teens and teen parents - Buntis 1 or Buntis 2 for pregnant women and their partners


3. Invite participants to Usapan. FP service providers can invite their target clients through the usual activities in their health facilities. These include the EPI day, which is usually held weekly in most rural health units (RHUs) and barangay (village) health stations (BHS), and Family Development Sessions (FDS). They can also mobilize their BHWs and CHT partners to invite potential clients. For U-BIBA, exert extra efforts to invite the parents/guardians of teens who can provide consent should the teens decide to use FP. 4. Select and set up the venue. The RHU or BHS is an ideal venue, since the providers and the materials are already there. Make sure, however, that there is sufficient space for a circular group of 15 persons, and auditory privacy especially for sessions with teens. Designate a waiting area for accompanying parents of U-BIBA participants. If it is difficult for the participants to come to the RHU or BHS, identify an alternative venue that is accessible to them (example: Barangay Hall, community centers, and basketball courts). 5. Prepare the supplies and materials. The following can serve as a checklist of essential supplies and materials: - FP commodities - Equipment and instruments for intrauterine device (IUD) insertion - Poster of FP methods (limiting OR spacing) - Attendance sheet and small pieces of paper numbered 1-15 - FP Form1 and TCL - Mother and Baby Book (for Buntis 1) - Materials for participatory exercises (seeds, small pieces of paper, sticks, cut-outs,

drawings) - Handouts of specific FP methods - Reproductive Life Plan (for U-BIBA) - Consent form (for U-BIBA) - Referral slips (for BTL, PPIUD, NSV) - Snacks (optional) 6. Finalize arrangements with service providers for methods that would be given at a

later date. Facilitators should finalize necessary arrangements with referral facilities, private service providers, and itinerant teams. 7. Recruit a satisfied FP user from within the community of the participants. Find someone who, despite facing similar challenges and having no extra resources or knowledge than her/his peers has successfully embraced FP and is now enjoying its benefits. 8. Prepare yourself and your co-facilitators.


Before running the sessions, facilitators should discuss among themselves the division of tasks and responsibilities. At the onset, they should agree on which topic and task each facilitator will handle. These tasks may include, but are not limited to, counseling, service provision, and managing the sessions. For U-BIBA, assign one facilitator who will do a separate FP talk with accompanying parents. Facilitators should also request the assistance of other service providers, if necessary.

Steps in facilitating the enhanced Usapan sessions

Usapang Kuntento Na Duration: 30-40 minutes Materials:

- Attendance sheet - Small pieces of paper numbered 1 to 15 - 15 pieces of small (about 3X3 inches) cards - Poster of FP methods Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all

the cells are filled out. - Give each participant a small piece of paper with numbers corresponding to her/his number

in the attendance sheet. - Review the column on fertility intention in the attendance sheet. Anyone in need of spacing

may be directed to individual counseling and immediate service provision. Only those in need of limiting should remain for the session, as the Usapang Kuntento Na is specifically for limiters.

2. Introduction - Introduction should not take more than five minutes. - Thank the participants for coming to the session. - Divide them into pairs. Each member will introduce the other (name, number of children,

and what I observed about her/him today). You may modify the third piece of information (example: movie star lookalike). Encourage the participants to be humorous. The facilitators will introduce themselves first to provide an example of how the introduction is done.

- Take note of the number of children of each participant, as this information will be used in

the Kumustahang Buhay section.


3. Expectations - This section should not take more than one minute. - To elicit participants’ expectations from the session, ask about three to five participants:

Sa inyong palagay, bakit po kayo inimbitahan dito? Para saan po ba ang session na ito? (Why were you invited today? What is this session for?)

- Thank them for their time and effort. - Emphasize that they have all decided not to have children anymore, and congratulate them

for wanting to learn more about what they can do as mothers/ fathers. - Invite them to give everyone a round of applause. 4. Kumustahang Buhay - This section runs for about five minutes.

- The facilitator recalls the number of children of each participant shared during the

introduction before asking the following:

a. Anu-ano po ang pinagkakaabalahan ninyo sa maghapon (What keeps you busy the whole day)?

b. Madali po ba kayong mapagod (Do you get tired easily)? c. Kulang po ba ang oras sa maghapon para sa inyong mga gawain (Do you have enough

time for all your tasks)? d. Sapat po ba ng inyong tulog sa gabi (Do you have enough sleep at night)? e. May panahon pa po ba kayo para maglibang (Do you have time for leisure)? f. Ano po ang gusto ninyo para sa inyong sarili (What do you want to do for yourself)?

5. Fertility Intention and Aspirations - This part of the session runs for two minutes. - Ask the participants the following questions:

a. Ano po ang dahilan kung bakit ayaw na ninyong mag-anak (Why do you want to stop having children)?

b. Ano po ang gusto ninyo para sa inyong mga anak (What do you want for your children)?

6. “Break bread” exercise - This exercise runs for five minutes. - Label small cards as oras (time), pagkain (food), pera (money), atensyon (attention), pag-

aaral (education), bahay (shelter), damit (clothing), etc. - Give each participant a card and ask them to divide their cards in equal parts according to

the number of household members.


- Ask each how she/he feels about the resulting pieces. - Ask the participants: Ano po ang mangyayari kung madaragdagan pa ang inyong anak

(What will happen if you have more children)?

7. FP practice - This section takes about one minute. - Ask the participants: Ano po ang ginagawa/gagawin ninyo para di na magkaanak (What do

you do/will do to limit childbirth)? 8. FP Methods - This section takes about five minutes only. - Present the safe and effective FP methods for limiting:

Ito po ang mga ligtas at epektibong paraan para ‘di na magkaanak (These are the safe and effective FP methods for limiting childbirth: IUD, progestin subdermal implants (PSI), BTL, and NSV. Discuss only the basics of each method; discussion of side effects, myths and misconceptions, and mechanism of action can be done during one-on-one counseling.

9. Testimony - This section takes three minutes. - Emphasize that here is someone who, despite facing similar challenges and having no

extra resources or knowledge than her/his peers, has successfully embraced long-acting reversible contraception (LARC) or long-acting permanent methods (LAPM) and is now enjoying the benefits of FP.

10. Method choice - This section takes about one minute. - Ask the participants: Sa puntong ito, may FP method ba na gusto na ninyong gamitin?

Pakisulat po sa papel na ibinigay sa inyo kaninang bago tayo nagsimula (At this point, do you want to use a specific FP method? Please write it down on the piece of paper given to you at the beginning of the session).

- Collect the papers. Update the last columns of the attendance sheet. Indicate specific

method of choice. Indicate also if the participant is undecided. - Thank the participants for attending the session and ask those who selected a method to

stay on for the one-on-one counseling and provision of service. - If provision of service is on a later date, inform them of the date, place and time, and what

they need to prepare. Provide them with referral slips.


- One of the facilitators should also talk to those who did not choose a method. Explore the possibility of follow-up.

Usapang Pwede Pa Duration: 30-40 minutes Materials: - Attendance sheet - Small pieces of paper numbered 1 to 15 - Grains of rice or corn - Poster of FP methods Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all

the cells are filled out.

- Give each participant a small piece of paper with numbers corresponding to her/his number in the attendance sheet.

- Review the column on fertility intention in the attendance sheet. Anyone in need of limiting

may be directed to individual counseling and immediate service provision. Only those in need of spacing should remain for the session, as the Usapang Pwede Pa is specifically for spacers.




the Kumustahang Buhay section. 3. Expectations - This section should not take more than one minute. - To elicit participants’ expectations from the session, ask about three to five participants:

Sa inyong palagay, bakit po kayo inimbitahan dito? Para saan po ba ang session na ito?


(Why were you invited today? What is this session for?) - Thank them for their time and effort. - Emphasize that they have all decided not to have another child soon, and congratulate

them for wanting to learn more about what they can do as mothers/ fathers. - Invite them to give everyone a round of applause. 4. Kumustahang Buhay - This section runs for about five minutes. - The facilitator recalls the number of children of each participant shared during the



b. Madali po ba kayong mapagod (Do you get tired easily)? c. Kulang po ba ang oras sa maghapon para sa inyong mga gawain (Do you have

enough time for all your tasks)? d. Sapat po ba ng inyong tulog sa gabi (Do you have enough sleep at night)? e. May panahon pa po ba kayo para maglibang (Do you have time for leisure)? f. Ano po ang gusto ninyo para sa inyong sarili (What do you want to do for yourself)?

5. Fertility Intention and Aspirations - This part of the session runs for two minutes. - Ask the participants the following questions:

a. Ano po ang dahilan kung bakit ayaw muna ninyong mag-anak (Why do you want to space childbirth)?


6. “Planting Rice/Corn” Exercise - This exercise runs for five minutes. - Give a participant some grains of rice/corn. - Ask her/him to make two rows that are planted with the right amount of space between

grains. - Give another participant some grains of rice/corn. Ask her/him to make four rows that are

planted close together. - Ask the participants:

a. Paano ang pagtubo ng bigas/mais sa dalawang magkaibang taniman (How will the rice/corn grow in the two different fields)?

b. Alin ang magiging mas masigla at matatag (Which one will be more lively and strong)?


c. Alin ang magbubunga nang mas marami at maganda (Which will be more fruitful and beautiful)?

d. Ano ang mangyayari kung ang bigas/mais ay itinanim nang sala sa panahon (What will happen if you planted the rice and corn at the wrong time)?

- Relate the discussion to FP, delaying birth, and proper spacing, as well as reducing risks

for mothers and babies.

7. FP Practice

- This section takes about one minute. - Ask the participants: Ano po ang ginagawa/gagawin ninyo para di muna magkaanak (What

do you do/will do to space childbirth)?

8. FP Methods - This section takes about five minutes only. - Present the safe and effective FP methods for spacing:

Ito po ang mga ligtas at epektibong paraan para ‘di muna magkaanak (These are the safe and effective FP methods to delay pregnancy): Lactational Amenorrhea (LAM), pills, injectable, PSI, IUD, condom, Standard Days Method (SDM). Discuss only the basics of each method; discussion of side effects, myths and misconceptions, and mechanism of action can be done during one-on-one counseling.

9. Testimony - This section takes three minutes. - Emphasize that here is someone who, despite facing similar challenges and having no

extra resources or knowledge than her/his peers, has successfully birth spacing and is now enjoying the benefits of FP.

10. Method Choice - This section takes about one minute. - Ask the participants: Sa puntong ito, may FP method ba na gusto na ninyong gamitin?

Pakisulat po sa papel na ibinigay sa inyo kaninang bago tayo nagsimula (At this point, do you want to use a specific FP method? Please write it down on the piece of paper given to you at the beginning of the session).



stay on for the one-on-one counseling and provision of service.


- If provision of service is on a later date, inform them of the date, place and time, and what they need to prepare. Provide them with referral slips.

- One of the facilitators should also talk to those who did not choose a method. Explore the

possibility of follow-up.

Usapang Bagong Maginoo The Usapang Bagong Maginoo targets males who wish to limit the number of their children. Duration: 30 minutes Materials:

- Attendance sheet - Small pieces of paper numbered 1 to 15 - 15 pieces of small (about 3X3 inches) cards - Cutout images of crocodiles - Two long (about 5 or 6 feet) and narrow (about 2 inches) bamboo or wood slats - Poster of FP methods Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all


in the attendance sheet. - Review the column on fertility intention in the attendance sheet. Anyone in need of spacing

may be directed to individual counseling and immediate service provision. Only those in need of limiting should remain, as the Usapang Bagong Maginoo is specifically for limiters.







Sa inyong palagay, bakit po kayo inimbitahan dito? Para saan po ba ang session na ito? - (Why were you invited today? What is this session for?) - Thank them for their time and effort. - Emphasize that they have all decided not to have children anymore, and congratulate them

for wanting to learn more about what they can do as mothers/ fathers. - Invite them to give everyone a round of applause. 4. Kumustahang Buhay - This section runs for about five minutes. - The facilitator recalls the number of children of each participant shared during the



b. Madali po ba kayong mapagod (Do you get tired easily)? c. Ang asawa ninyo po, ano ang kanyang pinagkakaabalahan maghapon? Palagi po ba

siyang pagod (What keeps your wife busy all day? Is she always tired)? d. May panahon pa po ba kayo para maglibang kasama ang pamilya (Do you have time

for leisure with the family)? e. Ano po ang gusto ninyo para sa inyong sarili? Para sa inyong asawa (What do you

want to do for yourself? For your wife)? 5. Fertility Intention and Aspirations - This part of the session runs for two minutes. - Ask the participants the following questions:

a. Ano po ang dahilan kung bakit ayaw na ninyong mag-anak (Why do you want to stop having children)?


6. “Break bread” exercise - This exercise runs for five minutes. - Label small cards as oras (time), pagkain (food), pera (money), atensyon (attention), pag-

aaral (education), bahay (shelter), damit (clothing), etc.


- Give each participant a card and ask them to divide their cards in equal parts according to the number of household members.

- Ask each how she/he feels about the resulting pieces. - Ask the participants: Ano po ang mangyayari kung madaragdagan pa ang inyong anak

(What will happen if you have more children)? 7. Empathy: Gaano Kahirap Magbuntis at Manganak (How Hard is it to be Pregnant and

to Give Birth to Children)? “Spin and Cross the Bridge Exercise”

- This exercise should not take more than 5 minutes. - Place one narrow wooden “bridge” on the floor, with pictures of three crocodiles on either

side. - Ask one participant to spin once and cross the bridge. - If he crossed successfully, ask him to spin twice and cross again. - Continue with this cycle of spinning and then immediately crossing the bridge for three,

four, or more times, depending on the number of the participant’s children. - Relate this with the dangers (crocodiles, narrow bridge) of pregnancy and childbirth and the

difficulty of crossing the bridge when there are many children (number of spins). Emphasize that this is what women go through in life.

- Now place the second bridge parallel to the other bridge. - Ask the same volunteer to cross the river by making use of both bridges. - Ask what the second bridge represents. Emphasize the role of men in childbearing, birth,

childrearing, and FP. 8. FP Method - This section takes about five minutes only. - Present the safe and effective FP method to limit number of children:

Kung gusto ninyong suportahan ang inyong asawa at pamilya, may ligtas at epektibong paraan para di na magkaanak (If you want to support your wife and family, there is a safe and effective way to limit the number of your children): NSV. Since this is the only method that will be discussed, you may address all questions and concerns from the participants including side effects, myths and misconceptions.

9. Testimony - This section takes three minutes.


- Emphasize that here is someone who, despite facing similar challenges and having no

extra resources or knowledge than his peers, has successfully embraced NSV and is now enjoying the benefits of FP.

10. Method choice - This section takes about one minute. - Ask the participants: Sa puntong ito, handa na ba kayong magpa-NSV? Pakisulat po sa

papel na ibinigay sa inyo kaninang bago tayo nagsimula (At this point, do you want to undergo NSV? Please write it down on the piece of paper given to you at the beginning of the session).

- Collect the papers. Update the last columns of the attendance sheet. Indicate also if the

participant is undecided. - Thank the participants for attending the session and ask those who want to undergo NSV

to stay on for the one-on-one counseling and service provision. - If provision of service is on a later date, inform them of the date, place and time, and what

they need to prepare. Provide them with referral slips. - One of the facilitators should also talk to those who did not choose NSV. Explore the


Usapang Buntis 1 Duration: 30 minutes Materials: - Attendance sheet - Handout: Kwento ni Rose - Cutout pictures/drawings to illustrate Kwento ni Rose - Mother and baby book Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all

the cells are filled out. 2. Introduction - Introduction should not take more than five minutes. - Thank the participants for coming to the session.


- Divide them into pairs. Each member will introduce the other (name, number of children, and what I observed about her/him today). You may modify the third piece of information (example: movie star lookalike). Encourage the participants to be humorous. The facilitators will introduce themselves first to provide an example of how the introduction is done.


Sa inyong palagay, bakit po kayo inimbitahan dito? Para saan po ba ang session na ito? - Emphasize that they are going through a significant phase in their life, and congratulate

them for wanting to learn more about what they can do as mothers/fathers to ensure a safe pregnancy.

- Invite them to give everyone a round of applause. 4. Preparations for Childbirth - This section should run for two minutes. - Ask the participants what they do to prepare for their pregnancy and childbirth: Anu-anong

mga paghahanda ang inyong ginagawa para tiyaking ligtas ang inyong pagbubuntis (What preparations are you doing to ensure that your pregnancy is safe)?

- Ask the participants what their partner’s do and what they expect them to do to support

them. - Provide additional inputs. 5. Kwento ni Rose - This session should run for 5 minutes. - Distribute the handout “Kwento ni Rose,” which can be found in Annex B. - Read “Kwento ni Rose.” Cutout or framed drawings can be used to help make the story

come alive. - After reading the story, ask the participants: Bakit namatay si Rose (Why did Rose die)? - Inform the participants that 12 women in the country die every day during childbirth. - Ask the participants: Ano ang dapat gawin para di matulad kay Rose (What should be done

so we will not end up like Rose)?


6. 4ANC - This part of the session runs for five minutes. - Ask the participants: Ilang beses kayo dapat magpa-check up at tuwing kalian (How many

times and when should you go for medical consultations)? - Give participants the Mother and Baby Book. Direct them to the page about ANC.

Emphasize the ANC schedule of 1-1-2. Stress the importance of having the first visit within the first trimester and starting early with folic acid supplementation.

- Ask the participants: Ano ang ginagawa sa prenatal check-up? Bakit ito mahalaga (What is

done during prenatal check-ups? Why is it important)? - Explain each step in a prenatal consultation. 7. Birth Plan - Ask the participants: Mayroon na ba kayong birth plan? Bakit po ba ito mahalaga (Do you

have a birth plan? Why is it important)? - Refer to the Birth Plan page in the Mother and Baby Book. Explain the steps in birth

planning. - Emphasize the role of the partner in birth planning. Ask them how they involve their

partners in birth planning. 8. Emergency Signs - This portion takes about two minutes. - Ask the participants: Paano ninyo malalaman kung mapanganib ang inyong pagbubuntis?

(How will you know if you have a risky pregnancy)? - Refer to the danger signs page in the Mother and Baby Book. Ask participants if they know

how to spot an emergency and when they need to go to a hospital/clinic. - Ask the participants: Ano-ano ang mga palatandaan ng emergency (What are the signs of

an emergency)? - Ask them if their partners are aware of these emergency signs and if they know what to do

if they experience any of these signs. 9. Healthy Pregnancy Practices - This portion takes about one minute. - Ask the participants: Anu-ano ang mga kailangan ninyong gawin at ng inyong partner para

mapanatili ang malusog na pagbubuntis (What do you and your partner need to do to ensure a healthy pregnancy)? Refer to the healthy pregnancy practices list in the Mother and Baby Book.


10. Skilled Birth Attendance (SBA)/Facility-based Delivery (FBD) - Ask the participants: Saan ninyo pinaplanong manganak (Where do you intend to give

birth)? - Emphasize the dangers of home delivery. Refer to the Mother and Baby Book. - Inform them of PhilHealth benefits. For non-members, mention the range of possible cost of

birth delivery in the nearest health facility (validate cost first). - Stress affordability and safety of FBD. 11. Birth preparedness - This portion takes about two minutes.

- Ask the participants: Ano-ano ang mga kailangang mong ihanda bago manganak?

Pagkatapos manganak (What are the steps you need to do before giving birth? After giving birth)? Refer to the list in the Mother and Baby Book.

- Ask if their partners know how to support them before and after giving birth. 12. Exclusive Breastfeeding (EBF) - This section takes three minutes. - Ask participants if they plan to breastfeed and if they know how to breastfeed: May plano

ba kayong magpasuso? Alam ba ninyo ang tamang pagpapasuso (Do you plan to breastfeed? Do you know the right way to breastfeed)?

- Refer to the section on EBF in the Mother and Baby Book. Ask why ‘early initiation,’

‘exclusive,’ and ‘extended’ breastfeeding are important. - Define the three criteria for EBF. - Discuss the benefits of EBF (e.g. health and economic benefits). 13. Rewriting Rose’s Story - This section runs for three minutes. - Show a drawing of Rose standing on the bank of a wide river, with the words “Healthy

Nanay (Mother). On the other side of the river are the words Healthy Baby”. - Tell them that previously, Rose dove into the dangerous, deep water without knowing how

to swim. - Ask them what Rose and her baby need to cross the river safely.

a. Bangka (boat)= Birth Plan


b. Katig (rigger)= 4ANC c. Sagwan = healthy pregnancy practices d. Life vest = FBD e. Life vest for Baby = EBF

- Emphasize the role of their partners. 14. Closing - This portion takes a minute. - Thank the participants for attending the session. Ask them to stay for their ANC, to discuss

the birth plan with their partners, and to always refer to the Mother and Baby Book to learn more about pregnancy and childbirth.

- Inform them that on the last trimester of their pregnancy, they will be called again for

another discussion.

Usapang Buntis 2 Duration: 30 minutes Materials: - Attendance sheet - Kwento ni Rose illustrations/cutouts - Small pieces of paper numbered 1 to 15 - Grains of rice or corn - 15 pieces of small (about 3X3 inches) cards - Poster of FP methods Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all

the cells are filled out. - Give each participant a small piece of paper with numbers corresponding to her number in

the attendance sheet. 2. Introduction - Introduction should not take more than five minutes. - Thank the participants for coming to the session. - Divide them into pairs. Each member will introduce the other (name, number of children,

and what I observed about her/him today). You may modify the third piece of information (example: movie star lookalike). Encourage the participants to be humorous. The


facilitators will introduce themselves first to provide an example of how the introduction is done.


the Kumustahang Pagbubuntis section. 3. Expectations - This section should not take more than one minute.

- To elicit participants’ expectations from the session, ask about three to five participants:


- Thank them for their time and effort.

- Emphasize that they are going through a significant phase in their life, and congratulate them for wanting to learn more about what they can do as mothers/fathers to ensure a safe pregnancy.

- Invite them to give everyone a round of applause. 4. Kumustahang Pagbubuntis - This portion runs for about 5 minutes. - Ask the participants the following questions:

a. Kumusta po ang inyong pagbubuntis (How is your pregnancy)? b. Nasunod po ba ninyo ang ANC schedule? Kailan po kayo babalik sa center (Were

you able to follow your ANC schedule? When will you go back to the center)? c. Nahihirapan po ba kayo (Are you having a difficult time)? d. Nakakakain ba kayo nang tama? Umiinom ng maraming tubig? Nag-eexercise?

Natutulog nang sapat (Are you able to eat right? Do you drink lots of water? Do you exercise? Do you get enough sleep)?

e. Mabigat po ba ang inyong mga gawain sa maghapon (Do you have a heavy daily workload)?

f. Saan po kayo manganganak (Where will you give birth)? 5. Review of Kwento ni Rose - This portion should run for 5 minutes. - Ask the participants: Do you remember “Ang Kwento ni Rose?” - Re-tell the story and show the drawing of how her story can be re-written. - Review the importance of ANC, healthy pregnancy practices, emergency signs, FBD, and

EBF. - Add the importance of post-partum care.


6. Fertility intention and aspirations - This section takes about two minutes. - Ask the participants the following:

a. Ano po ang plano ninyo pagkatapos manganak (What is your plan after giving birth)? b. Gusto pa po ba ninyong mag-anak (Do you still want to have more children)? c. Sa mga gusto pa, kailan po ninyo gustong mag-anak muli (For those of you who want

more children, when do you want to have more children)? d. Ano po ang gusto ninyo para sa inyong mga anak (What do you want for your

children)? - At this point, divide the participants according to fertility intentions. In one corner of the

room, one facilitator will handle the “Planting rice/corn exercise with the spacers. In another corner, a separate facilitator will handle the “break bread” exercise.

7. Simultaneous participatory exercises 7.1 “Planting Rice/Corn” Exercise - This exercise runs for five minutes. - Give a participant some grains of rice/corn. - Ask her/him to make two rows that are perfectly planted with the right amount of space

between grains. - Give another participant some grains of rice/corn. Ask her/him to make four rows that are


a. Paano ang pagtubo ng palay/mais sa dalawang magkaibang taniman (How will the rice/corn grow in the two different fields)?

b. Alin ang magiging mas masigla at matatag (Which one will be more lively and strong)? c. Alin ang magbubunga ng mas marami at maganda (Which will be more productive and

beautiful)? d. Ano ang mangyayari kung ang palay/mais ay itinanim nang sala sa panahon (What will

happen if you planted the rice and corn at the wrong time)? - Relate the discussion to FP, delaying birth, and proper spacing, as well as reducing risks

for mothers and babies. 7.2 “Break Bread” Exercise - This exercise runs for five minutes. - Label small cards as oras (time), pagkain (food), pera (money), atensyon (attention), pag-

aaral (education), bahay (shelter), damit (clothing), etc.


- Give each participant a card and ask them to divide their cards in equal parts according to

the number of household members. - Ask each how she/he feels about the resulting pieces. Ask the participants: Ano po ang mangyayari kung madaragdagan pa ang inyong anak (What will happen if you have more children)? 8. FP Practice - This section takes about one minute.

- Ask the participants: Ano po ang ginagawa/gagawin ninyo para di muna magkaanak (What

do you do/will do to space childbirth)? Ano po ang ginagawa/gagawin ninyo para di na mag-anak (What do you do/will do to limit childbirth)?

9. FP Methods - This section takes about five minutes only.

- Present the safe and effective FP methods for spacing:

Ito po ang mga ligtas at epektibong paraan para ‘di muna magkaanak (These are the safe and effective FP methods to delay pregnancy): Lactational Amenorrhea (LAM), pills, injectable, PSI, IUD, condom, Standard Days Method (SDM). Discuss only the basics of each method; discussion of side effects, myths and misconceptions, and mechanism of action can be done during one-on-one counseling.

- Present the safe and effective FP methods for limiting:

Ito po ang mga ligtas at epektibong paraan para ‘di na magkaanak (These are the safe and effective FP methods for limiting: PPIUD, progestin subdermal implants (PSI), PPBTL, and NSV. Discuss only the basics of each method; discussion of side effects, myths and misconceptions, and mechanism of action can be done during one-on-one counseling.

10. Testimony - This section takes three minutes.

- Emphasize that here is someone who, despite facing similar challenges and having no

extra resources or knowledge than her/his peers, has successfully embraced postpartum FP and is now enjoying its benefits.

11. Method Choice - This section takes about one minute.

- Ask the participants: Sa puntong ito, may FP method ba na gusto na ninyong gamitin?

Pakisulat po sa papel na ibinigay sa inyo kaninang bago tayo nagsimula (At this point, do


you want to use a specific FP method? Please write it down on the piece of paper given to you at the beginning of the session).



stay on for the one-on-one counseling.

- Since they are all pregnant, provision of service will be post-partum. Provide them with referral slips.

- One of the facilitators should also talk to those who did not choose a method. Explore the


Usapang Batang Ina at Batang Ama (U-BIBA) Duration: 30-40 minutes Materials: - Attendance sheet - Small pieces of paper numbered 1 to 15 - Grains of rice or corn - Poster of FP methods Procedure: 1. Registration - As the participants arrive, ask them to fill out the attendance sheet (Annex A). Check if all


in the attendance sheet. - Review the column on fertility intention in the attendance sheet. Anyone in need of limiting

may be directed to individual counseling and immediate service provision. Only those in need of spacing should remain for the session, as the U-BIBA is specifically for spacers.


and what I observed about her/him today). You may modify the third piece of information (example: movie star lookalike). Encourage the participants to be humorous. The


facilitators will introduce themselves first to provide an example of how the introduction is done.



3. Expectations

- This section should not take more than one minute. - To elicit participants’ expectations from the session, ask about three to five participants:


- Thank them for their time and effort. - Emphasize that they are all going through important changes in their lives, and

congratulate them for wanting to learn more about what they can do as young mothers/ fathers.

- Invite them to give everyone a round of applause. 4. Kumustahang Buhay - This section runs for about five minutes. - The facilitator recalls the number of children of each participant shared during the


a. Anu-ano ang mga dati ninyong ginagawa na hindi na ninyo nagagawa ngayon? (What did you used to do that you cannot do anymore?)

b. Anu-ano ang mga ginagawa ninyo ngayon na hindi ninyo dati ginagawa? (What are you doing now that you did not used to do?)

c. Mabigat ba ang responsibilidad ng may anak/asawa? Do you think having children or getting married is a huge responsibility?

5. Fertility Intention and Aspirations - This part of the session runs for one minute. - Ask the participants the following questions:

a. Ano po ang dahilan kung bakit ayaw muna ninyong mag-anak (Why do you want to space childbirth)?


6. “Planting Rice/Corn” Exercise - This exercise runs for five minutes.


- Give a participant some grains of rice/corn. - Ask her/him to make two rows that are planted with the right amount of space between

grains. - Give another participant some grains of rice/corn. Ask her/him to make four rows that are


a. Paano ang pagtubo ng bigas/mais sa dalawang magkaibang taniman (How will the rice/corn grow in the two different fields)?

b. Alin ang magiging mas masigla at matatag (Which one will be more lively and strong)? c. Alin ang magbubunga nang mas marami at maganda (Which will be more fruitful and

beautiful)? d. Ano ang mangyayari kung ang bigas/mais ay itinanim nang sala sa panahon (What will

happen if you planted the rice and corn at the wrong time)? - Relate the discussion to FP, delaying birth, and proper spacing, as well as reducing risks

for mothers and babies. 7. Facilitate the Reproductive Life Plan - Para matulungan tayong makapagplano ng pagbubuntis at panganganak, maari tayong

gumamit ng Reproductive Life Plan. (To help us plan our pregnancy and childbirth, we can use the Reproductive Life Plan.)

- Distribute copies of the RLP. 7.1. Introduce the tool by explaining: What it is all about: Plano sa pag-aanak sa buong panahong maaaring magbuntis. What to consider: Isipin ang personal na kalusugan, kalusugan ng bata, mga prioridad at

pangarap, at katayuan sa buhay. How to plan: Sagutan ang mga tanong, tingnan ang kabuuan ng plano, isaalang-alang ang

rekomendasyon ng HSP, baguhin kung kinakailangan, pumili ng FP method kung gusto.


7.2. Call attention to the red (or shaded) parts - Give message about the healthiest years to be pregnant, and the dangers of “too young”

and “too old”. 7.3. Fill out “name” and encircle “age”. 7.4. Answer question #1. 7.5. Answer question #2 and #3. Verify response by asking age/s of children. 7.6. Answer question #3. Verify response by asking age/s of children. 7.7. Answer question #4. Mark also if unsure. 7.8. Answer question #5. Allow multiple answers. 7.9. Reflect and ask:

a. How they feel about the graph: Ano ang masasabi ninyo sa naging takbo (dalas at

agwat) ng inyong pagbubuntis? b. How the situation fits into what they want: Pinagplanuhan ba ninyo ito? Naaayon ba ito

sa inyong kagustuhan? c. How the situation affects various aspects of their life: May epekto ba ito sa inyong

kalusugan? Sa kalusugan ng bata/mga bata? Sa inyong mga prioridad at pangarap? d. If they intend to have more children soon: Makapaghihintay ba kayo? Address their

concerns. e. Unsure if they want more children: Bakit di kayo sigurado sa inyong kagustuhan?

Address their concerns. f. Explain the benefits of HTSP and the risks of not using HTSP (for adolescents,

pregnant, post-partum, post-abortion, HP). Recall earlier discussion (“planting rice”) g. May gusto ba kayong baguhin sa inyong plano?

7.10. FP use - Ask about FP use: May ginagamit ba kayong FP method? Address their concerns. - For pregnant, post-partum, and post-abortion: discuss return to fertility and risks of getting

pregnant again. - Discuss FP methods. - Relate HTSP with their aspirations: Makakatulong ito para mas magawa ninyo ang inyong

mga prioridad at plano. - Ask: Ano ang pagkakaintindi ninyo sa ipinaliwanag ko? 7.11. Method choice May FP method ba na gusto ninyong gamitin? Markahan ninyo.


8. Close the session - Ask: May mga katanungan pa po ba kayo? Kung wala na, paki-pirmahan ang plano sa

itaas at ilagay ang petsa ngayon. - Call attention to the last part: Ibahagi ang plano, kumonsulta sa HSP kung may

pagbabago, at panatilihing malusog ang pangangatawan. - Collect the RLPs: Hihiramin lang po namin ang inyong mga plano. - Using the Attendance Sheet, update the last columns. Indicate specific method of

choice. Indicate in this column if undecided or not interested. - If accepting a method, prepare consent form and FP Form 1. - Give back the RLPs. - Thank participants for attending the session and ask those who chose an FP method

to stay on for the one-on-one counseling (with the parents/guardians) and provision of service.

- If provision of service is on a later date, inform them of the date, place and time, and what they need to prepare. Provide referral slips.

- One of the facilitators should also talk to those who did not choose a method. Explore the possibility of follow-up.


ANNEXES



Annex A



Annex B Kwento ni Rose

Si Rose ay 24, may dalawang anak, walang trabaho. Ang asawa niya ay laborer sa bukid. Sunud-sunod ang kanilang mga anak: ang panganay na babae ay 2 taon pa lamang, habang ang pangalawang babae ay 1 taon.

Limang buwan pagka-panganak ni Rose sa pangalawa ay buntis na naman siya. Ayaw na sana niyang mag-anak pero gusto ng asawa niya na magdagdag ng dalawang lalaki.

Sa simula ay naging mahirap ang pagbubuntis ni Rose. Madalas siyang nanghihina at nahihilo. Inakala niyang normal ang kanyang nararamdaman. Hindi siya nagpatingin sa health center kahit minsan.

Noong malapit na ang kabuwanan niya, namaga ang kanyang mga binti, paa at kamay, at madalas siyang nilalagnat. Isang araw, dinugo si Rose at humilab ang kanyang tiyan. Sa pag-aakalang manganganak na siya, tumawag ng hilot ang kanyang asawa.

Pinahiran siya ng pinakuluang mga dahon para mawala ang lagnat; hinilot ang kanyang tiyan para mapadali ang paglabas ng bata. Sa pangalawang araw ay nag-kombulsyon si Rose. Doon na nagpasya ang hilot na ipadala si Rose sa ospital.

Dahil hindi nila napaghandaan ang pamasahe, inabot ng isa pang araw bago nakahiram ng pera ang kanyang asawa. Dahil malayo ang kanilang sitio sa bayan, inabot pa ng tatlong oras ang malubak na biyahe.

Pagdating sa ospital, pinayuhan silang lumipat sa mas malaking ospital na may kakayahang humawak ng kasong emergency. Pagdating sa mas malaking ospital, patay na si Rose. Pinilit isalba ang batang lalaki sa kanyang tiyan, pero namatay rin ito pagkalipas ng limang oras.

Araw-araw, may mga katulad ni Rose sa Pilipinas.

Bakit namatay si Rose?



Annex C



Annex D



Annex E



Documents

Guide to Organizing and Facilitating Usapan Final