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Community-based Distribution (CBD) of DMPA

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Research in sub-Saharan Africa, Asia, and Latin America shows that properly trained paramedical personnel can safely administer injectable contraceptives in community-based programs. This research, combined with necessary training measures, supports efforts to scale-up community based distribution (CBD) of depot-medroxyprogesterone acetate (DMPA), a progestin-only injectable.
  
For example, the results of an intervention study — jointly conducted by Family Health International and Save the Children, USA — of the community-based distribution CBD of DMPA in Nakasongola, Uganda, confirm that well-trained community health workers can safely provide injectable contraceptives like DMPA.
 
The study assessed the safety, quality, and feasibility of CBD of DMPA by comparing the clients of CBD workers with those of clinic-based providers; it involved 449 clients of CBD workers and 328 clients from local clinics. Differences between the women in the two groups suggest that the CBD workers recruited clients who had limited access to clinics, or were not typical clinic users. The results of the study led to these conclusions:
  • Contraceptive prevalence in Nakasongola increased by about five percentage points after the CBD of DMPA was introduced
  • DMPA clients of CBD workers were as satisfied with their choice of method and the quality of care they received as were clinic-based clients
  • The study had difficulty recruiting clinic-based clients, suggesting that many women prefer the CBD of DMPA to clinic-based provision
  • Women receiving DMPA from CBD workers continued using the method just as long as their clinic-going counterparts did
  • Clients in both groups reported few problems resulting from the DMPA injections and no accidental needle sticks
  • Based on the results of the study, Ugandan health officials decided to continue the CBD of DMPA in Nakasongola and expand it to other districts
Although the Nakasongola study illustrates merely one successful implementation of CBD of DMPA, this research adds to the global body of evidence that community-based services can provide quality care to individuals throughout the world. This is especially important in developing nations where access to care may be limited, and supports the idea that CBD of contraceptives can serve unmet family planning needs of women who live in rural communities and isolated urban areas, thereby increasing contraceptive use and considerably expanding access to high-quality family planning.