title: Provision of DMPA by community health workers: what the evidence shows.
abstract: BACKGROUND
  To reduce a large unmet need for family planning in many developing countries, governments are increasingly looking to community health workers (CHWs) as an effective service delivery option for health care and as a feasible option to increase access to family planning services. This article synthesizes evidence on the feasibility, safety and effectiveness of community-based delivery of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA).
  
  
  METHODS
  Manual and electronic search and systematic review of published and unpublished documents on delivery of contraceptive injectables by CHWs.
  
  
  RESULTS
  Of 600 identified documents, 19 had adequate information on injectables, almost exclusively intramuscular DMPA, provided by CHWs. The data showed that appropriately trained CHW demonstrate competency in screening clients, providing DMPA injections safely and counseling on side effects, although counseling appears equally suboptimal in both clinic and community settings. Clients and CHWs report high rates of satisfaction with community-based provision of DMPA. Provision of DMPA in community-based programs using CHWs expanded access to underserved clients and led to increased uptake of family planning services.
  
  
  CONCLUSIONS
  We conclude that DMPA can be provided safely by appropriately trained and supervised CHWs. The benefits of community-based provision of DMPA by CHWs outweigh any potential risks, and past experiences support increasing investments in and expansion of these programs.
authors.affiliation: Office of Population and Reproductive Health, Bureau for Global Health, USAID, Washington, DC 20523-3600, USA. smalarcher@usaid.gov
authors.forename: Shawn
authors.initials: S
authors.lastname: Malarcher
authors.forename: Olav
authors.initials: O
authors.lastname: Meirik
authors.forename: Elena
authors.initials: E
authors.lastname: Lebetkin
authors.forename: Iqbal
authors.initials: I
authors.lastname: Shah
authors.forename: Jeff
authors.initials: J
authors.lastname: Spieler
authors.forename: John
authors.initials: J
authors.lastname: Stanback
mesh_terms: D003150:Community Health Workers; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D010342:Patient Acceptance of Health Care
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate