Researcher at University Research Co.

Researcher (Consultancy/Short Term Technical Assistant)

In the conduct of Formative Research to Identify Behavioral Determinants of Lactational Amenorrhea Method (LAM) Use and Transition to Modern Family Planning Methods

I. BACKGROUND AND RATIONALE

During the first year of BARMMHealth project implementation, it has been realized through data review and stakeholder consultations that women who delivered babies recently have limited access to information on modern contraceptive methods hence, delay transition from LAM to modern contraceptives which results in unplanned or unintended pregnancy. It was also observed that a lot of postpartum women were identified to be LAM users. Notedly, drop-out rates for the said method are high and would account for potential unmet needs. Initially, BARMMHealth plans to conduct operational research to closely examine the practice of LAM and to generate evidence of missed opportunities to help women of the region to successfully transition from LAM to modern methods.

In 2017, BARMM’s modern Contraceptive Prevalence Rate (mCPR) was at 18.7% compared to 41.13% nationally. Despite the wide gap, BARMM’s rate of increase in mCPR was 1-percentage point from NDHS 2013-2017. On the other hand, at the national level, the rate of increase in CPR is 0.6-percentage point. It underscores that BARMM has made great strides but remains one of the weakest regions in terms of the use of modern family planning method. LAM is a World Health Organization (WHO) recommended method of modern family planning. Islam recognizes the health importance of exclusive breastfeeding for the first six months for the health benefits and well-being of the infant and the mother being an obligatory duty of parents as embodied in the Qur’an that says, “The mother shall suckle their children for two whole years for those who wish to complete the period of suckling.” (Suratul-Baqarah, 2:233).

LAM accounts for less than 1% of contraceptive use (NDHS, 2017) nationally and in BARMM. However, the Field Health Service and Information System (FHSIS, 2018) shows that countrywide, LAM accounts for 10.86% of all methods, whereas, it is nearly double in BARMM at 20.75%. In BARMM, LAM ranks as the third-highest used method next to pills (33.02%) and injectable (33.15%). For new acceptors, about 49.57% are LAM users (FHSIS, 2018), accounting for half of the Family Planning (FP) methods and outranking Oral Contraceptive Pills (OCP) and injectable. A study to evaluate LAM compliance found that at three months postpartum, 97% of women either met LAM criteria or had shifted to a non-LAM modern family planning method. In the 6th month, 87% of women no longer met LAM criteria and of these, only 31% had shifted to an alternative modern family planning method. This means that at six-month postpartum, 56% of the women were not protected against pregnancy through any modern family planning method. There are no existing studies on LAM in BARMM, particularly whether the LAM users meet the criteria, the extent of unmet need post-LAM, or whether they shift to a more intermediate or long-acting FP method.

In BARMM, provincial service statistics reported that nearly half of new acceptors are using LAM but users also drop out at a higher rate too. As a regular practice among health workers in the region, LAM is reported as the method in use of any woman who deliver her baby in a health facility was then “initiated into breastfeeding”.

Towards the end of the 2020 FY, BARMMHealth will launch the LAM operational research in Maguindanao and Sulu identified research sites based on representativeness, a commitment of DOH to support the implementation within 6 months.

II. STTA OBJECTIVES & DELIVERABLES

“BARMMHealth project is being implemented to improve maternal and child health status by making high-quality family planning services available. As part of the project, the LAM research is conducted to understand how to support lactating women to choose and accept an appropriate method of family planning for her if she chooses to do so. This STTA consultant will assist in the following LAM activities:

BARMMHealth has recognized that in the BARMM areas, the practice of family planning has not been considered seriously by the women of childbearing ages, despite the region-wide advocacy. This is manifested by the low rate of adoption of the prescribed family planning methods.

WHO has advocated the adoption of the Lactational Amenorrhea Method or LAM which is acceptable to Islam as it encourages the mother to breastfeed her infant and be safe from pregnancy for months. However, the drop-out rate of LAM use had been observed to be high among women in the BARMM.

There is then a need for a vigorous campaign to shift to the government-prescribed family planning methods aligned to the mandates of RA Republic Act 10354 or the Responsible Parenthood and Reproductive Health Act of 2012. BARMMHealth conceptualized an intervention program to enable the women to shift to shift to the modern family planning methods.

This research will yield data on: (a) The knowledge, attitudes and behaviors in relation to LAM use and transition from LAM to other family planning methods; (b) factors that serve as facilitators and barriers to the transition to LAM among postpartum women; (c) The current knowledge, attitudes and practices regarding Lam an FP counselling and service provision among community health workers and the health care providers who support them; and, (d) recommendations on behavior change interventions.

Plan of Activities

1. Literature Review – (1st phase) results of similar/relevant researches from MOH/DOH or other all relevant studies done elsewhere;
2. Finalize sampling design and methodology.
3. Drafting, revising and finalization of inception plan concerning the implementation.
4. Review and update the study protocol based on the review of literature.
5. Organize and facilitate the training of data collectors.
6. Review, pretest, and lead in the translation of data collection/interview tools.
7. Oversee the data collection and ensure respectful data gathering.
8. Actual Conduct of the Research based on detailed inception plan.
9. Monitoring and supervise the conduct of the formative research.
10. Processing of data and production of the research report
11. Presentation of the Results to the research and the BARMMHealth team.
12. Finalization of the research report
13. Dissemination of full research report
14. Work with the COP, DCOP/HSQI Director, and FP Specialist.
15. Coordinate and work with the HSQI Director and FP Specialist to train a select group of data collectors.
16. Coordinate with BARMMHealth DCOP/HSQI Director, MOH, and Provincial partners for the implementation/launching of the Research
17. Take the lead on monitoring the research implementation and continuous data collections within 6 months.
18. Provide the COP/ DCOP-HSQI Director field reports periodically (weekly, monthly, and quarterly) as needed.

This consultancy will be for the period starting on May 10, 2021, to September 30, 2021, for a maximum of 63 person-days.

Expected Outputs

Outputs of this TA include contact /meeting reports following the phases of engagement, such as:

1. Inception plan
2. Periodic reports (weekly, monthly and quarterly updates)
3. Results of the formative research/ preparation for the research design.
4. Report on the training of data collectors
5. Translated data collection tools
6. Data collection report and analysis in 6 months
7. Narrative consultancy report and PPT

III. MINIMUM QUALIFICATION REQUIREMENTS

In line with the specified scope of work detailed above and expected outputs, the STTA provider should preferably possess the following essential specialization, skills, and competencies:

1. A development professional, with background on education or women’s studies, or with specialization in the field of public health, and/ or experience on gender equality in the context of BARMM;
2. Preferably a resident researcher in BARMM, and highly familiar with the culture of the people, social and gender norms and practices, and favorable in reproductive health and rights of individuals;
3. Has extensive knowledge of operations research, population, and development, gender, adolescent –youth health and development.
4. Proven track record and extensive experience in training and technical writing.
5. Excellent communications and presentation skills including oral and written communication.
6. Results-oriented with proven ability to work independently or in a teamwork environment; and
7. Excellent computer skills.

IV. PERIOD OF PERFORMANCE AND LEVEL OF EFFORTS

This consultancy will be for the period starting on August 24, 2020 to April 16, 2021 for a maximum of 63 person-days.

Below are the expected deliverables and corresponding estimated level of effort in person days.

Contents of Deliverables

Activities LOE (p-days) Due Date

1. Inception plan 5 days Week 3 (May)

Discuss with BARMMHealth the nature and extent of Scope of Work

Prepare, discuss with BARMMHealth, finalize the Inception Plan

Assist in preparing additional documents required by the Ethics Review Committee for approval of LAM study protocol

1. Phase 1: Literature Review 5 days Week 4 (May)

Conduct literature search, data collection and analysis of that literature.

Develop selection criteria, including relevant theory, evidence, and practice on LAM use and transition from LAM based on relevant information on literature review.

1. Phase 2: Key Informant Interviews 20 days Week 1 (June to Aug 15)

Determine and finalize sample size and the stratified sampling of key informants.

Pretest, translate/enhance if necessary, finalize and standardize the interview tools.

Work with DCOP-T to facilitate the training of data collectors

Supervise the enumerators during the conduct of interviews in person when possible, and via phone or online when necessary.

Monitor the data collection continuously 20 days Week 1 (June to Aug 15)

Review all interview results for completeness and missing information and followed up for clarifications beyond the original process of follow-up and probing.

Perform thematic content analysis and support in the research’s overall analysis and recommendations.

1. Phase 3: Participant Group Research

Finalize site selection based on criteria and enhance the sampling methodology and interview tools.

Supervise data collection/gathering following the semi-structured barrier analysis interviews and in-depth interviews.

Assist in developing the sampling frame and coordinate with BARMMHealth field staff in facilitating BHWs to identify select respondents and in following up with these respondents.

Supervise data collectors on the conduct of interviews.

Ensure data entry will be performed by a trained and dedicated team.

The data analysis will seek to compare the transitioners and non-transitioners for the nine behavioural determinants of the LAM transition specified above.

1. Consultancy report writing and submission

End-line data collection (end of 6 months)

End-line Data analysis and report writing

Write consultancy report (narrative and PPT) 10 days Aug 16 to Aug 30, 2021

1. Dissemination of key findings and results 3 days Sept 15, 2021

Assist in the preparation and in designing and facilitating the dissemination forum of Research findings/results

Total LOE 63 days

V. PAYMENT TERMS

BARMMHealth will release the payment for services upon presentation of invoice by the

STTA researcher on completion of services rendered and acceptance of the report by the DCOP-T/HSQI Director. Invoices shall include the total number of days worked and a brief description of the services provided, along with documents cited as deliverables. Fees are subject to 10% withholding tax as mandated by Philippine law, deductible from each release. BARMMHealth will remit taxes withheld to the Bureau of Internal Revenue.

Expenses for consultant’s travel, accommodation and per diem will be arranged and shouldered by BARMMHealth in accordance with URC Business and Travel Expenses Guide

Expenses incurred in activities like consultation meetings, workshop/ write shops, trainings, and equipment and logistical requirements will be directly shouldered by BARMMHealth.

Payment will be made in five (5) tranches, following the completion of documents and activities required for this consultancy activities as detailed below:

VI. TECHINCAL DIRECTION

The STTA Consultant will work closely with the PIC-Quality Improvement Director. The STTA Consultant will also work in close collaboration and coordination with MOH Research Division and BARMMHealth Provincial teams in BARMM provinces. The PIC-Quality Improvement Director will accept and approve the deliverables.