Expanding contraceptive service delivery: findings from Mozambique’s first pilot assessing safety and acceptability of community-based distribution of injectable contraceptives through community health workers

Ana Jacinto, Pathfinder International
Ndola Prata, University of California, Berkeley
Cassimo Bique, Mozambican Association of Obstetricians and Gynaecologists (AMOG)
Momade Usta, Pathfinder International
Mahomed Riaz Mobaracaly, Pathfinder International
Rita Badiani, Pathfinder International

The objective of the study aimed to explore the effectiveness of training two cadres of CHWs (traditional birth attendants [TBAs] and polyvalent elementary health workers [APEs]) to administer DMPA, and to provide evidence to policy-makers on the feasibility of expanding community-based distribution of DMPA in areas where these two cadres of CHWs are present The TBAs and APEs enrolled and administered the first DMPA injection to a total of 1,432 eligible women. The majority of women in the study started using contraception for the first time during the study period and very few experienced side effects or morbidities at the injection site. Satisfaction with CHW was high, and improved over the study period. Continuation rates for DMPA were high for three-month and six-month injections, with higher continuation rates among TBA clients (91%) than APE clients (68%). Clients’ reported willingness to pay for DMPA (64%) highlights the latent demand for injectable contraceptives.