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Reproductive Health |
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This kit provides information and tools with which decision-makers can advocate for and initiate community-based distribution (CBD) of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA or Depo-Provera). Drawing on research and programs from Africa, Asia, and Latin America, the kit presents seven briefs with evidence supporting the safety and efficacy of CBD provision of DMPA. It discusses best practices for successful CBD of DMPA provision, such as training, counseling, and ensuring supply. The kit also includes overviews of resources and steps for initiating CBD of DMPA provision within existing reproductive health programs, as well as a checklist for screening clients who want to use DMPA. The checklist is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use.
Brief 1: Expanding Access to Injectable Contraception Although DMPA is a popular choice among family planning clients, many women cannot access clinics where DMPA is typically provided. This brief discusses the approach of offering DMPA through community-based distribution, which can address the unmet family planning needs of women, especially in rural areas. Brief 2: Safety of Community-based Distribution of DMPA Injectable contraceptives are extremely safe for most women, and can be safely provided by properly trained personnel in community-based distribution programs. Brief 3: Effectiveness of Community-based Distribution of DMPA Depo-Provera is one of the most effective contraceptives available as long as women receive their injections every three months. CBD workers need to be well trained and supported by clinics to help them ensure that they have plenty of supplies, can locate their clients, provide proper client counseling, and are trained to rule out pregnancy. Brief 4: Integrating Community-based Distribution of DMPA into Existing Health Systems There is no universal plan for integrating CBD of DMPA into an existing health system. However, this brief discusses several technical and logistical issues that are essential to consider before proceeding with such integration. Brief 5: Community-based Distribution of DMPA: The Nakasongola Project, Uganda A study in Nakasongola, Uganda demonstrated the safety, quality, and feasibility of community-based distribution of DMPA. This brief describes the study and its findings. Brief 6: Community-based Distribution of DMPA: The APROFAM Project, Guatemala Community-based provision of DMPA increased contraceptive uptake and benefited hard-to-reach populations in Guatemala. This brief describes a CBD project by APROFAM and its findings. Brief 7: Community-based Distribution of DMPA: The Matlab Project, Bangladesh This brief describes the results of a program to provide community-based distribution of injectable contraceptives in Bangladesh, where CBD programs were integrated into existing comprehensive reproductive health programs. Steps to Begin Providing DMPA through Community-based Services This list of steps is designed to help family planning policy-makers and program managers determine whether and how to begin providing DMPA through existing community-based services. Selected CBD of DMPA Resources This bibliography lists some important resources on CBD of DMPA, including journal articles, reference materials, provider tools, and lessons learned. Many of the resources are available on the Web, and links to these are provided. Checklist for Screening Clients Who Want to Initiate Use of DMPA (or NET-EN) (PDF, 215 KB) This checklist is designed for use by both clinical and nonclinical health care providers. It consists of 13 questions designed to identify medical conditions that would prevent safe DMPA use or require further screening. |
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