Project Dates: February 2014 – April 2015
Community-based access to injectable contraceptives in two districts in Mozambique
In the Family Planning Strategy 2010- 2014, the Ministry of Health in Mozambique 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 this strategy 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 contraceptives in two districts in Mozambique.The study aimed to explore the effectiveness of training two groups of community-based agents, APEs and traditional birth attendants (TBAs), to administer injectable contraceptives, thus bringing women greater access to their preferred method of contraception. From February 2014 through April 2015, the pilot study was conducted in the Montepuez and Chiure districts of northern Mozambique. A total of 25 APEs and 34 TBAs from the pilot districts were selected to receive training on CBD of injectable contraceptives.
The findings from this pilot study support that community-based distribution of injectable contraceptives by APEs and TBAs is safe, feasible, effective and acceptable to women. Almost 63% of TBA clients and 65.6% of APE clients reported never using a method to prevent pregnancy prior to this project. Overall, the pilot study demonstrated a high continuation rate (81.1%) after three injections, and when compared to APE clients, TBA clients had significantly higher continuation rates both at three months and at six months. In total, less than 0.5% of women reported any issue. Additionally, most clients reported no side effects at 3-month and at 6-month follow-up. Most women were satisfied with their provider; overall, at six months, dissatisfaction with the provider was low (9% among TBA clients and 4% among APE clients).
Funding: USAID/Washington; Pathfinder Mozambique
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 elucidated the enabling factors and barriers to family planning uptake in the postpartum period. Interviews with postpartum women aimed to explore their experiences with the injectable contraceptive 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. 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.
Funding: USAID/Washington; Bixby Center at UC Berkeley