256708 Expanding Access to Family Planning through Community-Based Services in Zambia: A Longitudinal Study

Tuesday, October 30, 2012 : 8:30 AM - 8:45 AM

Dawn Chin-Quee, PhD, MPH , Division of Health Services Research, FHI360, Durham, NC
Mavis Mwale, RN , Project Management, FHI 360/Zambia, Lusaka, Zambia
Lydia Jumbe, MSC, BSC, RM, RN , Family Planning, ChildFund Zambia, Lusaka, Zambia
Morrisa Malkin, MPH , Research Utilization, FHI 360, Durham, NC

In Zambia, facility-based family planning (FP) provision is low due to limited access. Global evidence suggests that community-based distributors (CBDs) play a crucial role in expanding access to FP services in rural districts. In 2009, the Zambian Ministry of Health approved training to administer Depo Provera (DMPA) for an initial 40 CBDs in ChildFund Zambia's (CFZ's) catchment areas in Mumbwa and Luangwa districts. We conducted a study to determine the safety, acceptability, impact, and cost of adding (DMPA) to CFZ's established FP program.


Longitudinal data were obtained from all CBD clients who were FP acceptors over the 12-month data collection period and from an overlapping 24-month period of district-level data to examine trends in DMPA uptake. Interviews were conducted with 11 CFZ and district supervisors, all CBDs, and 253 DMPA clients. Costs of adding DMPA to CFZ's FP program were tracked throughout the intervention.


No adverse events associated with injections occurred during training or were reported by clients. Of the 4,241 clients who received FP services during the study period, 82% accepted DMPA from a newly-trained CBD agent, and 41% were new to FP. Ninety-four percent of early acceptors received a second DMPA injection. Clients reported high levels of satisfaction with CBD provision of DMPA. Costs of protecting a couple from pregnancy for one year were higher than clinic provision but lower than costs for antenatal care in Zambia.


Based on the success of the program, the Zambian government decided to scale-up CBD-provision of DMPA nationwide.

Learning Areas:
Provision of health care to the public

Learning Objectives:
Demonstrate the safety, acceptability and impact of community-based provision of injectable contraception Assess the cost-effectiveness of adding injectable contraception services to community-based pill and condom provision

Keywords: Access and Services, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator that lead the study described in the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.