title: Safety and Acceptability of Community-Based Distribution of Injectable Contraceptives: A Pilot Project in Mozambique.
abstract: Mozambique has witnessed a climbing total fertility rate in the last 20 years. Nearly one-third of married women have an unmet need for family planning, but the supply of family planning services is not meeting the demand. This study aimed to explore the safety and effectiveness of training 2 cadres of community health workers-traditional birth attendants (TBAs) and agentes polivalentes elementares (APEs) (polyvalent elementary health workers)-to administer the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), and to provide evidence to policy makers on the feasibility of expanding community-based distribution of DMPA in areas where TBAs and APEs are present. A total of 1,432 women enrolled in the study between February 2014 and April 2015. The majority (63% to 66%) of women in the study started using contraception for the first time during the study period, and most women (over 66%) did not report side effects at the 3-month and 6-month follow-up visits. Very few (less than 0.5%) experienced morbidities at the injection site on the arm. Satisfaction with the performance of TBAs and APEs was high and improved over the study period. Overall, the project showed a high continuation rate (81.1%) after 3 injections, with TBA clients having significantly higher continuation rates than APE clients after 3 months and after 6 months. Clients' reported willingness to pay for DMPA (64%) highlights the latent demand for modern contraceptives. Given Mozambique's largely rural population and critical health care workforce shortage, community-based provision of family planning in general and of injectable contraceptives in particular, which has been shown to be safe, effective, and acceptable, is of crucial importance. This study demonstrates that community-based distribution of injectable contraceptives can provide access to family planning to a large group of women that previously had little or no access.
authors.affiliation: Pathfinder International, Watertown, MA, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Jacinto
authors.affiliation: Pathfinder International, Watertown, MA, USA.
authors.forename: Mahomed Riaz
authors.initials: MR
authors.lastname: Mobaracaly
authors.affiliation: Mozambican Association of Obstetricians and Gynaecologist, Maputo, Mozambique.
authors.forename: Momade Bay
authors.initials: MB
authors.lastname: Ustáb
authors.affiliation: Mozambican Association of Obstetricians and Gynaecologist, Maputo, Mozambique.
authors.forename: Cassimo
authors.initials: C
authors.lastname: Bique
authors.affiliation: University of California, Bixby Center for Population, Health and Sustainability, Berkeley, CA, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Blazer
authors.affiliation: University of California, Bixby Center for Population, Health and Sustainability, Berkeley, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Weidert
authors.affiliation: University of California, Bixby Center for Population, Health and Sustainability, Berkeley, CA, USA ndola@berkeley.edu.
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003695:Delivery of Health Care / Q000379:methods*; D005193:Family Planning Services / Q000600:supply & distribution; D005240:Feasibility Studies; D005260:Female; D005298:Fertility; D006301:Health Services Needs and Demand; D006801:Humans; D007267:Injections; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects; D008880:Midwifery; D009073:Mozambique; D017060:Patient Satisfaction; D010865:Pilot Projects; D012111:Residence Characteristics; D012424:Rural Population; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate