PATH materials make emergency contraception accessible to diverse ethnic groups

How can a contraceptive method that’s been available in the United States for more than five years remain one of public health’s “best kept secrets”?

It’s easy if the method is seldom publicized and family planning materials neglect to mention it. It’s even easier if women don’t speak the language that available information is in.

In 1997, PATH and our partners decided to let the cat out of the bag. Recognizing the importance of reaching underserved ethnic and language groups with information about emergency contraception (EC), PATH and public health groups in Washington State established the Northwest Emergency Contraception Coalition. Together we developed a manual that enables providers to share EC information—including a client brochure and use instructions—with clients who speak Amharic, Arabic, Cambodian, Chinese, English, Haitian-Creole, Korean, Laotian, Portuguese, Russian, Somali, Spanish, or Vietnamese. These materials were the first in a series of activities designed to increase the flow of EC information to women in diverse groups.

Informing the information providers

The coalition’s efforts also sparked a partnership between PATH and Washington State that equipped providers with the knowledge and materials they need to increase clients’ awareness of EC.

PATH developed a training toolkit that includes a portfolio of materials: question-and-answer sheets, EC referral cards, a sample telephone-screening protocol, information about the brands and doses of oral contraceptive pills that can be used for EC, training curricula for both clinical and nonclinical providers, and medical and service delivery guidelines. The team also created wallet-sized client brochures in five languages: Chinese, English, Russian, Spanish, and Vietnamese.

After developing the toolkit in 1999, PATH worked with the Washington State Department of Health and Department of Social and Health Services to train their health and social service providers to use the materials. As a result, EC is no longer a “secret” in Washington; public health and social service providers routinely provide women with EC services and EC information.

A discrete but appealing brochure for clients

PATH developed and tested the wallet-sized brochures with women who were native speakers of each of the five languages. The focus groups revealed many insights. During a focus group session, for example, Latina participants debated whether the woman pictured on a Spanish-language EC brochure should be pictured alone or with a man next to her. “It’s our decision when to have a baby,” said one woman. “The man should be involved and support us,” said another. They finally agreed that the image allowed for many interpretations and that it was attractive and appropriate—so attractive, in fact, that several women said they would pin the brochure to the wall next to their beds. This enthusiasm was unexpected, as health workers had advised PATH to develop a brochure that clients could discretely put in their pocket or purse.

In additional sessions, participants liked the small size of the brochure, which is designed to fit into a wallet, so the team maintained that format. The brochure provides basic information about EC and where it can be obtained. To create English, Spanish, Russian, Chinese, and Vietnamese versions, PATH selected culturally appropriate art, photographs and text and carefully pretested the materials. Once printed, the materials prompted requests from across the United States. “There is just nothing out there in these languages that is specific to EC,” one clinician from a family planning center in New York noted. “This is the first I’ve seen, and they’re very popular.”

Making a difference

These materials have helped health care providers in the United States counsel their clients more effectively. The proportion of clinical providers who talk about EC with clients more than 30 times per year increased from 52 percent to 86 percent in the last year of the project, and the percentage of social service providers who reported being “very familiar” with EC rose from 47 to 62 percent. In addition, the activities led to an increase in EC information available through local health jurisdictions from 66 percent in 1999 to 80 percent in 2001.

The project also spurred state agencies across the country to use and adapt the client materials and provider tools. As one correspondent wrote, “I just wanted you to know that I used the toolkit last week. I based a presentation to Girls Inc. health educators on your nonclinical module. It was such a success that I received applause at the end.” The materials have also generated demand overseas, prompting PATH’s team in Kenya to publish a series of wallet-size trifold brochures for clients in their vicinity.

Photo: PATH.