On World Contraception Day, a Call to Increase Access to Injectable Contraceptives

Today, September 26, marks World Contraception Day.

Presently, more than 222 million women worldwide want to avoid pregnancy, but they are not using a modern method of contraception. Improving access to family planning programs and contraception is essential to help lift women and their families out of poverty around the globe.

Family Planning 2020 (FP2020), a global partnership, is working to reach 120 million new users of contraception in the world’s 69 poorest countries by 2020. This goal can only be achieved if contraceptive services are extended beyond the facility and into communities, reaching the millions of women and couples whom the health system fails to reach effectively.

Community-based family planning programs that include injectable contraceptives can expand access to a woman’s preferred contraceptive method, reduce unmet need for family planning in underserved areas, and address the critical health workforce shortage in many countries. In sub-Saharan Africa, injectables are the most popular method for women using modern contraception. By 2015, worldwide use is projected to reach nearly 40 million—more than triple the 1995 level (1). Injectable contraceptives hold appeal for many women who seek a modern family planning method, particularly since it is effective, lasts for 13 weeks, and can be used privately. However, health officials in some developing countries have been reluctant to approve community-based distribution of injectables because of concern about the ability of non-clinicians to uphold safety and quality standards when screening clients for medical eligibility, administering injections, disposing of used needles or delivering timely reinjections. Other concerns include fear that community health workers (CHWs) could displace clinicians and offer services that they are not qualified to deliver.

These concerns are understandable but misguided. For the past 50 years, worldwide experience has shown that CHWs can be trained to offer informed-choice counseling and safely provide pills, condoms, and spermicides. More recently, technical experts concluded that CHWs can safely offer injectables and educate women and couples to use fertility awareness methods, such as the Lactational Amenorrhea Method (LAM) and Standard Days Method (SDM). CHWs have provided injectable contraceptives such as Depo-Provera in more than a dozen countries in sub-Saharan Africa, as well as Afghanistan, Bangladesh, Bolivia, Guatemala, Pakistan, and Peru.

Expanding this model of community-based family planning through CHWs can reach more women and couples, increase available contraceptive options, improve continuation of contraceptive methods, and increase the number of new family planning users, thus helping to meet the goals of FP2020.

The Advancing Partners & Communities Project, funded by USAID and implemented by JSI Research & Training Institute, Inc. and FHI 360, has developed an advocates package, the Community Health Worker Provision of Injectable Contraceptives: An Effective CBA2I Strategy. Thispackage includes a series of six targeted advocacy resources and a DVD to help promote CHW provision of injectable contraceptives through new and existing community-based family planning programs. These resources are intended to be used by advocates, program managers, policymakers, donors, ministry of health staff, and other key stakeholders such as faith-based groups, media, and family planning champions. Download the advocates package and help expand community-based programs that help women and their families meet their family planning needs.

It’s your life; it’s your future; know your options.

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(1) ROSS, J., STOVER, J., and ADELAJA, D. 2005. Profiles for family planning and reproductive health programs: 116 countries. Futures Group. Available at: http://www.constellafutures.com/Documents/Profiles116FP2ed.pdf.

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