Abstract
BackgroundEfforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs).MethodsThis paper reports on results of the impact of a randomized cluster trial of CHA deployment on contraceptive uptake among 3078 baseline and 2551 endline women of reproductive age residing in 50 intervention and 51 comparison villages in Tanzania. Qualitative data were collected to broaden understanding of method preference, reasons for choice, and factors that explain non-use.ResultsRegression difference-in-differences results show that doorstep provision of oral contraceptive pills and condoms was associated with a null effect on modern contraceptive uptake [p = 0.822; CI 0.857; 1.229]. Discussions suggest that expanding geographic access without efforts to improve spousal and social support, respect preference for injectable contraceptives, and address perceived risk of side-effects offset the benefits of adopting contraceptives provided by community-based services.ConclusionsThe results of this study demonstrate that increasing access to services does not necessarily catalyze contraceptive use as method choice and spousal dynamics are key components of demand for contraception. Findings attest to the importance of strategies that respond to the climate of demand.Trial registrationControlled-Trial.comISRCTN96819844. Retrospectively registered on 29.03.2012.
Highlights
Efforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs)
This study demonstrates that increasing community access of some contraceptive methods by CHAs does not necessarily help improve contraceptive use, and that
This policy has involved shifting a range of public health services to community health workers, including the provision of reproductive health services, expanding the pool of trained health workers who are extending the reach of primary health care and family planning to areas where coverage is otherwise sparse [11]
Summary
Efforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs). Despite several decades of policy commitment and investment in programs, the widespread need to improve family planning (FP) services persists in much of rural Africa [1,2,3]. Most sub-Saharan countries have pursued policies that attempt to solve this problem with strategies that deploy community workers to distribute care at the community level [8,9,10] In recent years, this policy has involved shifting a range of public health services to community health workers, including the provision of reproductive health services, expanding the pool of trained health workers who are extending the reach of primary health care and family planning to areas where coverage is otherwise sparse [11]. Women who are interviewed about non-use underscore ways in which the social barriers to using family planning services are compounded by the economic costs of taking time to travel to the facility [16]
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