Family Health Research:
The Community-based Distribution of Injectable Contraceptives

Injectable contraceptives are increasingly popular for many reasons, including their safety, effectiveness, ease of use, privacy, and convenience. In sub-Saharan Africa, injectables are the most widely used contraceptive method, chosen by more than 38 million women. But many eligible women have limited access to injectable contraceptives because these methods are typically provided through clinical services.
 
This newsletter examines the potential for encouraging sustained use of contraception by training community-based health workers to provide injectable methods. A pilot study conducted in Uganda's Nakasongola District demonstrated that such health workers can safely and efficiently provide injectable contraceptives. The evidence from this pilot project and the availability of safer injection technologies are prompting governments in Kenya, Madagascar, and other countries to test the community-based distribution of injectable contraceptives. 

We invite readers to share their experiences with the community-based distribution of injectable contraceptives and to send comments to our forum, so please send us your comments.

In this issue:

Providing Injectable Contraceptives in Communities

Experience from Asia, Latin America, and, most recently, sub-Saharan Africa, shows that the community-based distribution (CBD) of injectable methods can be safe and effective. Established CBD programs can add these popular methods to the services they provide at relatively low cost, but may need to strengthen their logistical systems to ensure consistent supplies of injectable contraceptives and injection equipment.

With careful training and supervision, community-based family planning workers can meet the requirements for the safe administration of injectable contraceptives, including proper client screening and counseling, good injection technique, and appropriate waste disposal. Disposable injection devices that become automatically disabled after a single use eliminate reuse of needles and reduce the risk of accidental needle sticks.

Madagascar Tests the CBD of DMPA

More than 60 community-based family planning workers are providing DMPA injections to women in remote rural communities through a pilot project that Madagascar's government plans to expand to other regions.

The CBD of DMPA in Uganda

The first study of the CBD of DMPA in sub-Saharan Africa, conducted by FHI and its partners in rural Uganda, found that community-based distribution is as safe as clinic-based services. Based on the results of this study, this CBD of DMPA program continues and has been expanded to two more districts in Uganda.

Learning from Uganda's Experience

What can other countries learn from Uganda's experience? A delegation of Kenyan policy-makers and health professionals visited Uganda to examine its CBD of DMPA pilot project firsthand. They discussed the lessons from the pilot project with Dr. Anthony Mbonye and other health officials and observed CBD workers such as Faith Mulekhwa counseling clients and administering injections.

Electronic Forum on the CBD of Injectables

The large number of people who registered to participate in an electronic forum about the CBD of injectable contraceptives is one sign of the growing interest in this approach. The forum, which was hosted by FHI and Management Sciences for Health via the Global Exchange Network in May 2007, drew 330 registrants to an online discussion about issues such as training requirements, safety measures, community participation, and advocacy.