PROJECT DATES: FEBRUARY 2014 – APRIL 2015
Community-based access to injectable contraceptives in two districts in Mozambique
Mozambique maintains a high total fertility rate of 5.9, with the highest levels of fertility found in rural areas (TFR 6.6) and among the poorest and least-educated women. Mozambique has made notable progress in increasing awareness and knowledge of family planning since the government established a family planning program in 1980, yet progress stalled between the 2003 and 2011 Demographic Health Surveys (DHS) due to the shifting of donor priorities from family planning to HIV. In fact, the 2011 DHS showed that only 11.3% of married women 15-49 years old used modern methods of contraception, which was a drastic decline from the previous DHS in 2003 when modern contraceptive prevalence was 20.6% among married women.
The Family Planning Strategy 2010- 2014, the Ministry of Health (MISAU) approved the revitalization of the Agente Polivalente Elementar (APE) program, as well as the use of traditional birth attendants (TBAs) to mobilize the community for increased utilization of family planning methods. Building on the momentum of this initiative and given the preference among Mozambican women for injectable contraceptives, the Bixby Center partnered with Pathfinder International and the Mozambican Association of Obstetrics and Gynecology to conduct a safety and feasibility assessment of a community based distribution program of injectable contraceptive DMPA (depot-medroxy progesterone acetate) in two districts in Mozambique. The study aimed to explore the effectiveness of training two groups of community-based agents, Agentes Polivalentes Elementares (APEs) and traditional birth attendants (TBAs), to administer DMPA, thus bringing women greater access to their preferred method of contraception. This study was completed in April 2015 and demonstrated that APEs and TBAs within a village can safely and effectively deliver DMPA with high acceptability among clients.
For more information on this study, please download the program brief.
Exploring community-based agents’ and postpartum women’s perceptions of community-based postpartum family planning in two districts in Mozambique
As a nested study to the project described above, the Bixby Center, in collaboration with the Mozambican Association of Obstetricians and Gynecologists, conducted 50 in-depth interviews with postpartum women and their community-based family planning providers. These interviews, which are still being analyzed, will elucidate the enabling factors and barriers to family planning uptake in the postpartum period. Interviews with postpartum women aimed to explore their experiences with the DMPA provision project, their opinions and perceptions of community-based providers, their assessment of risk of pregnancy in the postpartum period, and their perspectives on using contraception during this period. Interviews with community-based family planning agents uncovered their opinions of family planning use among postpartum women and how this affects service provision, interactions with postpartum women in the program, challenges delivering information about risk of pregnancy in the postpartum period, and perceptions of the program. Similar to the parent study, the long-term goal of this qualitative research was to develop a sustainable family planning distribution system that responds to low-resource, rural women’s needs and preferences without further burdening the skilled health workforce in Mozambique.