1. FGD guide: common/main part (for all groups)

Important note to the moderators:

-for each answer, go deep by continuing to ask why, why, why… till you thing you’ve reached the real cause; don’t leave answers superficial, take time to ask more till you feel you have heard something new that you did not already know.

-Be vigilant for participants’ non verbal communication & body language that could convey important messages or show that we’re perhaps being too direct or that we need to readjust our style and approach during the FGD. Always keep in mind that we are discussing very intimate and sensitive issues. Be very peculiar about the vocabulary you use. Such reactions from participants should be noted in details.

-Please probe with suggestions in parentheses, if the participants don’t talk about one of the aspects we need to learn more about;

-As often as possible, please always remember to probe with social-cultural, religious aspects and the power relations between men and women

1.0. Introduction

It will concern generalities, and creates an enabling environment to start real discussions or interviews. Moderators will among others introduce objectives and the purpose of the research, and explain approaches to be used. There will also be also negotiation of free consent to participate, reassure people about the confidential and anonimous character of the information they will provide, and make sure the participants are really the ones targeted by the subject, and according to the sampling and research plan.

Before formal start, there will be introductory questions related to the harvest, raining and dry season, to break barriers between moderators and FGD participants.

1.1.Participatory assessment of Knowledge, Attitudes and Practices on FP among target group and CARE staff, including participatory identification of socio-cultural barriers and of girls/women and boys/men’s respective role in FP/SRH. Assess positive and negative forces that must be addressed or that can be built on in future programming;

  1. In Rwanda, according to a recent survey, 95% of women and 98% of men aged of 15-49 years reported having knowledge of at least one method of contraception. However only 17% of women of child bearing age use a traditional Family Planning method and only 10% use of modern FP method,
  2. How can you find/explain this situation? (normal, terrible, average,
  1. The average number of children per women in Rwanda is 6.1, while about 4 women out of 10 (36%) non users of any method say they want to space or limit births
  2. What do you think of having more than 6 children per woman? According to you, are 6 children per women, per family too many children? Is it a good number of children? Or is it a low number of children?
  3. What could be the reasons for having 6 children or more per household? Let them answer first and then probe on the following: cultural, traditional, religious reasons, ignorance, children take care of parents as parents get older, women incapacity to refuse sex from her husband, women incapacity to use FP without husband’s consent, etc)
  4. Why do many women who want to space or limit births not use any method? Let them answer first, then probe: fear of secondary effects, etc. (cultural, traditional, religious, ignorance, women incapacity to refuse sex from her husband)
  1. What do you think about the following different reasons why some women are opposed to FP as per a recent survey:
  2. 22% of women reported the fear for health problems and secondary effects (reduced fecundity);
  3. What types of side effects women and men talk about?
  4. What kinds of health problems due to FP are women afraid of? ?
  5. Whyso many women (and perhaps men) are afraid of that?
  6. Could you share with us some concrete examples?

3.2.10% of women want to have as many children as possible

3.2.1.Why is it important for a woman to have many children in Rwanda?

3.2.2.What link between this will and

3.2.2.1.Rwandan culture

3.2.2.2.Religious beliefs,

3.2.2.3.Rwandan recent history of genocide and war

3.3.10% of women said in that recent survey that FP was forbidden by her religion:

3.3.1.Do you agree with the fact that religion is a barrier to FP?

3.3.2.Are all religions forbidding FP or are they some that allow the use of FP?

3.3.3.Do you have examples of some religions allowing FP and others that don’t?

3.3.4.Do you feel that you have sinned if you use FP while it is forbidden by your religion or religious leader?

3.3.5.If spacing the birth of your children allows you to take better care of your existing children, is using FP still a sin?

3.3.6.Could you consider using FP secretly to improve your own health and the health of your existing children without telling your religious leader or your partner? ,

3.3.7.Would you have tangible examples of some religious leaders using and/or promoting modern FP methods?

3.4.According to this same recent survey, 7%of women are themselves opposed to contraception and 4% said it was forbidden by their husbands/partners

3.4.1.Why are there more women opposed to contraception than their partners?

3.4.2.In general, who takes the decision about FP in the couple?

3.4.2.1.How do you explain this situation?

3.4.2.2.What would you like to see as changes? Probe a bit more asking what can be done to change the position of women and then the position of men

What could be the reasons for a woman to be opposed to contraception?

3.4.3.What could be the reasons for a man to be opposed to contraception?

3.4.4.Why is it important for you oryour partner to continue to have children even if it is very difficult to take good care of them (school fees, food, health care, etc…),

3.4.5.What about men position & power in the couple;

3.5.According to you, what are other possible barriers/challenges that women face to space and/or stop the birth of their children?. (First listen and then only Probe to explore barriers related to):

3.5.1.women submissiveness

3.5.2.Relatives and close friends influence;

3.5.3.Unavailability of services/Health centers and/or providers’ incompetence and willingness;

3.5.4.Traditional belief (try to be more specific and give examples) and Rwandan “pro-nativity” culture (describe in simple terms);

  1. Marginalized / vulnerable women and men (social inequalities)
  2. Are there certain community members who feel more pressured than others to have children / not have children? Who? Why?
  3. Are there certain community members who are interested in birth spacing but have troubles accessing FP services? Who? Why?
  4. Are there certain community members who are interested in birthspacing but have troubles actually using FP methods? Who? Why?
  5. Would you know relatives, friends or neighbors that want FP but don’t actually go to search for that at clinics? If so,
  6. What are the reasons they tell you (or you think) why they don’t go to clinics?
  7. What do you think of these reasons? Are they valid?
  8. If it was your case, what would you do?
  1. What categories of women do you think are more susceptible to be refused FP services while they want them? By whom are they refused access. Listen and then probe: husbands, mothers in law, religious network/leader, health center personnel. etc
  2. What could be the reasons?
  3. What are your advice to deal with those reasons?
  1. Tradition and customs
  2. Do people in Rwanda usually plan and space the birth of their children?
  3. If yes, how do people space births of their children traditionally?
  4. What are the traditional methods thar you know of and that are still being used today?
  5. Do you think they are effective and why?
  6. Why do people (or you) decide to use modern methods versus traditional one?
  7. For women who do not want to use modern FP,
  8. What are their reasons?
  9. Do they have any fears?
  10. Do men feel the same about it or do they have different reasons and fears?
  11. What are the customs around pregnancy and not getting pregnant (relating to being married and/or having sex ? outside of marriage, divorce, age, etc)?
  12. Are there times when women should not have children?When and why?
  13. Are there times when women should or are expected to have children?When and why?
  14. Are there times when men should not have children?When and why?
  15. Are there times when men should have children? When and why?
  16. How are these times determined?
  1. Social networks
  2. Who gets involved in discussions around when women should get pregnant or not? (Husbands, best friends, mothers-in-law, aunts, religious leaders, others…)
  3. Who do women go to for advice on (or not) getting pregnant and planning births of their children?
  4. Who plays a counseling role in the community for women on these issues? (Friends, in-laws, moms, grand moms, health animators, religious advisors)
  5. Among these people you just quoted as playing a counseling role, who is usually in favor of spacing births and who is against?

1.2.Gain knowledge on resisting and supporting socio-cultural factors and on factors associated with power relations between men and women that influence use of Family Planning services by women in general and vulnerable women in particular;

A. For USERS (to be administered to ARBEF clients)

  1. The couple
  2. In what ways are husbands involved in discussions and decisions on the following issues:
  3. Planning births?
  4. Using traditional or modern Family Planning methods?
  5. Do the opinions of women and men have equal weight?
  6. Who is more involved in FP in your couple?
  7. Who is more involved in FP in most couples you know?
  8. Why do you think so?
  9. What can be done to encourage the other partner (or you) to be “more” involved (or at the same level)?
  10. For you, what is the ideal number of children to have?
  11. Is there a preference for boys or girls for you?
  12. Why/why not?
  13. What about your close relatives and friends regarding the ideal number of children and sex preferences?
  1. Tell us how you begin the use of FP?
  2. Why did you decide to use a FP method? What exact event happened that made you decide to use a FP method?
  3. In general who decided first to go for FP among you and your spouse?
  4. What precise actions did you take personally in that way?
  5. What precise actions did your partner take in that way?
  6. How did your spouse react in the beginning?
  7. What are his/her reactions nowadays?
  1. Who is more concerned in FP in your couple?
  2. Why do you think so?
  3. What can be done to encourage the other partner (or you) to be “more” involved (or at the same level)?
  1. What have you done to overcome those challenges /barriers?

B. For non-users;

  1. What are specific reasons of not using FP?
  2. Your personal reasons
  3. Spouse’s personal reasons
  4. other reasons
  5. Have you ever used FP in your life?
  6. What are your discussions on that issue in your couple?

1.3. Integrate storytelling TLGin FGD;

Story telling Now, based on what we have been discussing, one of us (the moderator) will start a story on Family Planning in your community and each participant will add something to complete the story till it is finished. We will then discuss this story until everybody has expressed his views.

  • (Themoderator will start the story based on the socio-cultural factors revealed by the participants and then will ask the latter to continue, each one adding whatever he wants in FP, if possible a real experience (if possible is own, if not too sensitive in the group) or something he knows quite well. This should focus onsocio-cultural factors and on factors associated with power relations between men and women that influence use of Family Planning services by women.It is crucial to document the story in details.

TLG: Imagine that you have been given the power to respond to the challenges identified during these discussions related to socio-cultural factors and on factors associated with power relations between men and women that influence use of Family Planning services by women!

1.1.Tell us what you would do, how would you do it, from where would you start? With whom would you partner, why and how?.(Once one participant has finished his story, ask others to discuss about it. Would they do they same? Why? What would they do differently if they had the power? Why? What else would they do?

(During the storytelling, the moderator will probe to make sure participants express their views on key issues such as:

-factors linked to men power within the couple

-factors linked to women submissiveness

-factors linked to the culture

-factors linked to the religion)

2. Additional questions to CARE, Hospital & health centers and eventual stakeholders using community interactive theater or other innovative sensitizing strategies only

a. Additional questions to CARE staff,

1.4. Assess strategies for mainstreaming SRH/FP in existing programs

  1. Ideas/recommendations to mainstreamCARE’s FP programs (eg through our VSL groups,
  2. Do you see opportunities in CARE’s current programs in Rwanda to educate CARE’s beneficiaries on RH, particularly FP?
  3. Do you think CARE is using these opportunities? Why?
  4. What must CARE do to make use of these opportunities? (probe train staff, get additional resources, develop program approach, create more synergy between projects and sectors, etc)
  5. How can CARE pass messages on FP to the VSL group members, children in schools, out of schools, etc, in brief to CARE’s beneficiaries in general ?
  6. How can CARE integrate messages and education on RH and FP in all its programs (schools where it already works, Microfinance, HIV/AIDS, returnees, etc)
  7. How can CARE help Districts in integrating FP in their strategic plan and/or joint programs?
  1. How do you think CARE programs could assist CARE staff in relation to their own FP needs?
  2. Is there anything done by CARE in that sense currently? If not, do you think something should be done? Do you think there is a need for that?
  3. If yes, what exactly is being done?
  4. How do you appreciate that?
  5. What do you suggest as improvement?
  6. What exact elements would you like to add in CARE various programs in order to respond to FP needs of the staff?
  7. If not, How can CARE help meet its staff’s own reproductive health needs? (Eg by developing an IEC program on FP within CARE, or other ways)?

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b. Additional questions to Hospital & health centers officials & providers and CARE staff:

1.5. Identify local partners that use community interactive theatre or other participatory knowledge sharing and sensitization strategies in Rwanda. Assess the quality of theatre on FP (if existing) and/or assess their capacity to develop theatre that would address the socio-cultural barriers to FP and the role of men; If possible, test the feasibility and impact of such a strategy with a limited group of men and women;

  1. What other stakeholders in FP do you know in this region?
  2. Who are they?
  3. What are they doing?
  4. How do you appreciate their programs?
  5. What are their approaches in community sensitization?
  6. Do you know any of them who use community interactive theatre or other participatory approaches as sensitization strategies?
  7. If yes, tell us howyou have appreciated these approaches? How did communities respond to these approaches?
  8. What would you like them to change/add in order to respond to the community needs in FP?

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c. Specific to stakeholders using community interactive theater or other innovative sensitizing strategies:

1.6. In each District selected by this study, we will look for those stakeholders by contacting District hospitals and health centers. In case we find them, we will ask the following questions:

  1. What sensitization strategies do you use in FP?
  2. Tell us how you start these sensitization strategies?
  3. Why did you choose these methods?
  4. Why did you decide to use innovative strategies instead of classic ones?
  5. What kind of challenges do you face?
  6. How do you handle them?
  7. How does Community Theater help in addressing the socio-cultural barriers to FP and the role of men?
  8. What lessons did you learn so far using participatory approaches, such as theater or others in Family Planning interventions?
  9. What advices could you provide to other stakeholders who want to use Community Theater and other innovative strategies in sensitizing the community in FP?

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  1. What do you think of FP in general
  2. What are the advantages of FP?
  3. What do you appreciate more in FP
  4. What are the disadvantages?
  5. What don’t you like in FP?
  1. Are you or your spouse currently using any FP method?
  2. If yes which one? (if one say yes but don’t remember, name different FP methods to help him/her to remember)
  3. For how long have you been using FP?
  4. Why have you decided to use FP?
  5. Why are you using that specific method and not others?
  6. What advises could you provide to the new users of FP in general and to the users of this specific method in particular?

2.2.If not, why not? (Give options such as: breastfeeding, pregnant, not informed about existing methods, too expensive, too far, personally opposed to FP, husband/partner opposed to FP, fear of secondary effects of FP on health and fertility, forbidden by my religion, not aware of existing methods, etc. )

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