Building on Safety, Feasibility and Acceptability of Community Based Distribution of DMPA and Implications for Youth

Background: Improving the health conditions of Zambians is essential, especially in rural areas and among youth where access to health services is low. In 2009, ChildFund Zambia collaborated with FHI 360 on a pilot project to introduce injectable contraceptives into its existing Family Planning Integrated Health Program. The project’s study measured the impact of adding DMPA provision by CBD programs and assessed CBD agent’s ability to safely and effectively provide DMPA to clients.

 Methods: CBDs received training on DMPA including classroom demonstrations on providing injections, needle safety and needle stick injury infection prevention and treatment. CBDs were also provided with checklists for screening clients to determine medical eligibility to receive DMPA and referral forms for clients who report side effects and need treatment at local health posts. To increase RH information and awareness-raising throughout the community a cadre of youth peer educators were further supported as leaders for change.

Results: Approximately 35% of the women reported their first DMPA injection as their first use of a FP method. CBD agents safely provided injectable contraceptives; alleviating the workload of health facility staff and enhancing youth leadership through peer education. Client Continuation rates for Injectables (63%) were much higher than pills. Cost per CYP for combined FP methodology of pills and DMPA ranged from about US$11-$61. ChildFund’s CBD model for FP, and specifically DMPA, has been hailed as an effective service delivery program by the Zambian government and USAID and provides a great opportunity to focus on youth, thereby preventing high-risk pregnancies.