Increasing Access to Family Planning Services in Rural Mali Through Community-Based Distribution

Abstract

This study relied on pre-post surveys to examine the impact of community-based distribution (CBD) on increasing contraceptive knowledge and access in two rural subdistricts in southern Mali. The sampling frame was based on family registration data collected by Save the Children in 1991. The sample was a stratified random cluster sample among 81 villages in 3 study groups. Pretests included interviews in 1991-92 with 1495 women aged 15-49 years and 1499 men aged 18-60 years. Post-tests were conducted 18 months later in 1993-94 among 1289 women and 1262 men. The instrument was based on a KAP questionnaire for evaluating the national CBD project. The percentage who were able to identify at least one modern method increased significantly over time for women in all 3 groups. The largest increases were in the CBD group followed by the group that received education only. The control group had the lowest increases. The pill was the most widely known method in all groups. Knowledge increased similarly for men but the increases in the control group were insignificant. Ideal family size for women declined by 2 children to 6 children for the CBD and education only groups. None of the men showed a decline in desired family size. All study groups significantly increased modern method use especially the CBD group. Changes in spousal communication were significant for all groups. The number of acceptors and education activities increased throughout the study period. In Kolondieba the CBD program differed from other CBD efforts in Mali in its integration of CBD within an existing health care system.