Section 9: Monitor and Evaluate

Program managers rely on a variety of research methodologies and data sources for FP and MCH programs. All of these can be adapted or modified to address activities addressing AMA and HP pregnancies. For example, specific questions can be integrated into data collection tools. During analysis, data can be disaggregated by age and parity.

Specific indicators that assess the program’s effect on AMA and HP outcomes will be important to your program. Table 5 below lists suggested FP communication program variables and corresponding indicators.

Table 5: Suggested Communication Variables and Indicators

Knowledge

Variables	Indicators
Women at risk of AMA or HP and their partners know about the risks of AMA and HP pregnancies .	Percent of women at risk of AMA or male partners who know the risks of having children at or after age 35. Percent of women at risk of HP or male partners who know the risks of having five or more births.
Service providers have knowledge of the risks of AMA and HP pregnancies.	Percent of service providers who know at least three adverse health outcomes associated with AMA or HP pregnancies.
Women at risk of AMA or HP and their partners have knowledge of FP methods.	Percent of women at risk of AMA or HP or male partners who know three or more modern FP methods. Percent of women at risk of AMA or HP or male partners who know where to get a modern FP method. Percent of women at risk of AMA or HP or male partners who know about FP method side effects and how to manage them.

Variables

Indicators

Women at risk of AMA or HP and their partners know about the risks of .

Percent of women at risk of AMA or male partners who know the risks of having children at or after age 35.
Percent of women at risk of HP or male partners who know the risks of having five or more births.

Service providers have knowledge of the risks of AMA and HP pregnancies.

Percent of service providers who know at least three adverse health outcomes associated with AMA or HP pregnancies.

Women at risk of AMA or HP and their partners have knowledge of FP methods.

Percent of women at risk of AMA or HP or male partners who know three or more modern FP methods.
Percent of women at risk of AMA or HP or male partners who know where to get a modern FP method.
Percent of women at risk of AMA or HP or male partners who know about FP method side effects and how to manage them.

Perceived Risk

Variables	Indicators
Women at risk of AMA or HP and their partners perceive themselves to be at risk of adverse health outcomes from AMA or HP pregnancies.	Percent of women at risk of AMA or HP or male partners who know at least three increased risks of AMA or HP pregnancies.

Variables

Indicators

Women at risk of AMA or HP and their partners perceive themselves to be at risk of adverse health outcomes from AMA or HP pregnancies.

Percent of women at risk of AMA or HP or male partners who know at least three increased risks of AMA or HP pregnancies.

Beliefs

Variables	Indicators
Spacing and limiting pregnancies for women at risk of AMA or HP helps the mother and child stay healthy.	Percent of women at risk of AMA or HP or male partners who believe that spacing or limiting pregnancies helps the mother and child stay healthy.
Using FP will help a woman keep her figure and youthful looks.	Percent of women at risk of AMA or HP or male partners who believe that using modern FP methods will keep them looking beautiful.
Using FP will help a family face economic difficulties.	Percent of men and women who believe that using FP methods will help them face economic difficulties.

Variables

Indicators

Spacing and limiting pregnancies for women at risk of AMA or HP helps the mother and child stay healthy.

Percent of women at risk of AMA or HP or male partners who believe that spacing or limiting pregnancies helps the mother and child stay healthy.

Using FP will help a woman keep her figure and

Percent of women at risk of AMA or HP or male partners who believe that using modern FP methods will keep them looking beautiful.

Using FP will help a family face economic difficulties.

Percent of men and women who believe that using FP methods will help them face economic difficulties.

Attitudes

Variables	Indicators
Women should not have children at or after age 35.	Percent of women and men who believe women should not have children at or after age 35.
Couples agree to limit births to fewer than five per woman.	Percent of women and men who agree that fewer than five births per woman is sufficient.

Variables

Indicators

Women should not have children at or after age 35.

Percent of women and men who believe women should not have children at or after age 35.

Couples agree to limit births to fewer than five per woman.

Percent of women and men who agree that fewer than five births per woman is sufficient.

Social Influences/Norms

Variables	Indicators
Perceived approval of FP for limiting births before a woman is 35 or before parity five.	Percent of women or men who believe that others in their community approve of FP use for women at risk of AMA or HP.
Perceived use of FP for limiting births before age 35 or before parity five.	Percent of women or men who believe that others in their community are using FP to limit births before age 35 or before parity five.

Variables

Indicators

Perceived approval of FP for limiting births before a woman is 35 or before parity five.

Percent of women or men who believe that others in their community approve of FP use for women at risk of AMA or HP.

Perceived use of FP for limiting births before age 35 or before parity five.

Percent of women or men who believe that others in their community are using FP to limit births before age 35 or before parity five.

Interpersonal Communication

Variables	Indicators
Women at risk of AMA or HP have ever discussed FP with partner.	Percent of women at risk of AMA or HP who discussed FP with their partner.
Women at risk of AMA or HP discussed FP with someone in past six months.	Percent of women at risk of AMA or HP who discussed FP with someone in the past six months.
Women at risk of AMA or HP discussed FP with a health worker in past six months.	Percent of women at risk of AMA or HP who discussed FP with a health worker in last six months.

Variables

Indicators

Women at risk of AMA or HP have ever discussed FP with partner.

Percent of women at risk of AMA or HP who discussed FP with their partner.

Women at risk of AMA or HP discussed FP with someone in past six months.

Percent of women at risk of AMA or HP who discussed FP with someone in the past six months.

Women at risk of AMA or HP discussed FP with a health worker in past six months.

Percent of women at risk of AMA or HP who discussed FP with a health worker in last six months.

Behaviors

Variables	Indicators
Women at risk of AMA or HP using a modern FP method.	Percent of women age 35 or older who currently use a modern FP method. Percent of women with five or more births who currently use a modern FP method
Service providers counsel women at risk of AMA or HP and male partners on risks.	Percent of service providers who counsel women at risk of AMA or HP or male partners on the relevant risks.

Variables

Indicators

Women at risk of AMA or HP using a modern FP method.

Percent of women age 35 or older who currently use a modern FP method.
Percent of women with five or more births who currently use a modern FP method

Service providers counsel women at risk of AMA or HP and male partners on risks.

Percent of service providers who counsel women at risk of AMA or HP or male partners on the relevant risks.

Resources

For step-by-step guidance on developing a monitoring and evaluation plan, please see the HC3 guide How-to Develop a Monitoring and Evaluation Plan.

For more information on developing indicators, please see the HC3 guide How to Develop Monitoring Indicators.

Closing Thoughts

Focusing part of your SBCC effort on reducing AMA and HP pregnancy can be a novel way to help women, their partners and their communities find value in modern contraception. It can be a way to break down barriers and begin a fruitful dialogue on improving family health and welfare by making conscious decisions about the number and timing of pregnancies. In developing and implementing your SBCC strategy, remember to make sure that:

The motivations and concerns of both primary and important influencing audiences are taken into account
All statistics used are relevant to your audience and environment and are up to date
Images or photographs will be understood and recognized by your audiences (by pretesting them before printing)
Addressing difficult topics (such as limiting births) is balanced with providing information that is important and relevant to your audiences
Culture and religion are respected
Messages are consistent and credible
Language is appropriate for your audiences
A variety of complementary communication approaches are used

We wish you the best in this effort and, as mentioned earlier, we invite you to share your tools and experiences on Springboard or on the Health COMpass!

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