title: Evaluating a LARC Expansion Program in 14 Sub-Saharan African Countries: A Service Delivery Model for Meeting FP2020 Goals.
abstract: Objectives In many sub-Saharan African countries, the use of long-acting reversible contraceptives (LARCs) is low while unmet need for family planning (FP) remains high. We evaluated the effectiveness of a LARC access expansion initiative in reaching young, less educated, poor, and rural women. Methods Starting in 2008, Marie Stopes International (MSI) has implemented a cross-country expansion intervention to increase access to LARCs through static clinics, mobile outreach units, and social franchising of private sector providers. We analyzed routine service statistics for 2008-2014 and 2014 client exit interview data. Indicators of effectiveness were the number of LARCs provided and the percentages of LARC clients who had not used a modern contraceptive in the last 3 months ("adopters"); switched from a short-term contraceptive to a LARC ("switchers"); were aged <25; lived in extreme poverty; had not completed primary school; lived in rural areas; and reported satisfaction with their overall experience at the facility/site. Results Our annual LARC service distribution increased 1037 % (from 149,881 to over 1.7 million) over 2008-2014. Of 3816 LARC clients interviewed, 46 % were adopters and 46 % switchers; 37 % were aged 15-24, 42 % had not completed primary education, and 56 % lived in a rural location. Satisfaction with services received was rated 4.46 out of 5. Conclusions The effectiveness of the LARC expansion in these 14 sub-Saharan African FP programs demonstrates vast untapped potential for wider use of LARC methods, and suggests that this service delivery model is a plausible way to support FP 2020 goals of reaching those with an unmet need for FP.
authors.affiliation: Research and Knowledge Management, Innovations for Poverty Action, New Haven, CT, USA.
authors.forename: Thoai D
authors.initials: TD
authors.lastname: Ngo
authors.affiliation: Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, 1 Conway Street, London, W1T 6LP, UK.
authors.forename: Olivia
authors.initials: O
authors.lastname: Nuccio
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Shreya K
authors.initials: SK
authors.lastname: Pereira
authors.affiliation: Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, 1 Conway Street, London, W1T 6LP, UK. Katy.footman@mariestopes.org.
authors.forename: Katharine
authors.initials: K
authors.lastname: Footman
authors.affiliation: Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, 1 Conway Street, London, W1T 6LP, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Reiss
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D003267:Contraception / Q000379:methods*; D005193:Family Planning Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D000075523:Long-Acting Reversible Contraception / Q000706:statistics & numerical data*; D011247:Pregnancy
keywords: Family planning; Long-acting reversible contraception; Sub-Saharan Africa; Unmet need