Skip to main content

Radical Common Sense: Community Provision of Injectable Contraception in Africa

  • Chapter
  • First Online:
  • 1472 Accesses

Part of the book series: The Springer Series on Demographic Methods and Population Analysis ((PSDE,volume 33))

Abstract

Sub-Saharan Africa lags far behind the rest of the world in the use of family planning. Myriad factors contribute to low contraceptive prevalence in the region, but clearly, existing demand is not being met, and governments, donors and non-governmental organizations (NGOs) have failed to ensure access to a range of contraceptive options for Africa’s people. Rural areas are particularly neglected: clinics are few and far between, and typically offer few family planning choices. This chapter describes a recent innovation in sub-Saharan Africa that began to diffuse when four determining factors came into play simultaneously: (1) high unmet need for contraception, (2) strong preference for injectable family planning methods, (3) a critical shortage of clinical health workers, and (4) the existence of under-utilized, community-based family planning programs. The result of the innovation was logical, but radical: the provision of the continent’s favorite contraceptive by its lowest level health workers.

Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Notes

  1. 1.

    One review has estimated that, in many parts of the developing world, most injections are both unsafe and unnecessary (Simonsen et al. 1999). Another by the same authors estimated that, each year, unsafe injections are responsible for tens (or hundreds) of thousands of cases of HIV, and millions of cases of hepatitis (Kane et al. 1999).

  2. 2.

    In his 1962 book “Diffusion of Innovations,” Everett Rogers synthesized existing diffusion studies to popularize a theory for the adoption of innovative ideas and technologies through cultures. His theory defined five key characteristics of innovations that influence an individual’s decision to adopt or reject an innovation, which include its trialability and observability (see Rogers 1962; and Chap. 12 by Jacobstein in this book for more information).

  3. 3.

    The fact that these programs are donor-funded implies no criticism whatsoever of their value or usefulness. Nearly all family planning programs in sub-Saharan Africa rely partially or totally on donor funding. Community-based family planning programs are, if anything, particularly dependent, since they usually operate in remote areas and target the poorest of the poor.

  4. 4.

    However, several studies have shown that the lost bone mass is usually recouped after the method is discontinued (Kaunitz et al. 2008) and, more recently, calls to remove the black box warning have appeared (Kaunitz and Grimes 2011).

References

  • Abdul-hadi, R. A., Abass, M. M., Aiyenigba, B. O., Oseni, L. O., Odafe, S., Chabikuli, O. N., Ibrahim, M. D., Hamelmann, C., & Ladipo, O. A. (2013). The effectiveness of community based distribution of injectable contraceptives using community health extension workers in Gombe State, Northern Nigeria. African Journal of Reproductive Health, 17(2), 80–88.

    Google Scholar 

  • Akol, A., et al. (2009). Scaling up community-based access to injectables in Uganda: Lessons learned from private- and public-sector implementation. Research Triangle Park: Family Health International.

    Google Scholar 

  • Ashraf, A., Ahmed, S., & Phillips, J. F. (1997). The example of doorstep injectables. In Barkat-e-Khuda, T. T. Kane, J. F. Phillips (Eds), Improving the Bangladesh health and family planning programme. Lessons learned through operations research. Monograph No. 5. Dhaka: International Centre for Diarrhoeal Disease Research.

    Google Scholar 

  • Asuru, R., Phillips, J. F., Akumah I., et al. (2002, November 9–13). The success and failure of alternative strategies for community-based distribution of contraception in the Navrongo Project. American Public Health Association 130th Annual Meeting, Philadelphia.

    Google Scholar 

  • Beasley, A., White, K. O., & Westhoff, C. (2011). Self versus clinic administration of depot medroxyprogesterone acetate: A randomized controlled trial. Poster presented at the 59th Annual Clinical Meeting of American College of Obstetricians and Gynecologists, Washington, DC.

    Google Scholar 

  • Cameron, S. T., Glasier, A., & Johnstone, A. (2012). Pilot study of home self-administration of subcutaneous depo-medroxyprogesterone acetate for contraception. Contraception, 85(5), 458–464.

    Article  PubMed  CAS  Google Scholar 

  • Fernandez, V. H., Montúfar, E., Ottolenghi, E., et al. (1997). Injectable contraceptive service delivery provided by volunteer community promoters. Unpublished paper. New York: Population Council.

    Google Scholar 

  • Garza-Flores, J., Del Olmo, A. M., Fuziwara, J. L., et al. (1998). Introduction of cyclofem once-a-month injectable contraceptive in Mexico. Contraception, 58(1), 7–12.

    Article  PubMed  CAS  Google Scholar 

  • Gwatkin, D. R. (1979). Political will and family planning. Population and Development Review, 5(1), 29–59.

    Article  Google Scholar 

  • Heffron, R., Donnell, D., Rees, H., et al. (2012). Use of hormonal contraceptives and risk of HIV-1 transmission: A prospective cohort study. The Lancet Infectious Diseases, 12, 19–26.

    Article  PubMed  Google Scholar 

  • Hirve, S. (2005). Injectables as a choice – Evidence-based lesson. Indian Journal of Medical Ethics, 11(1), 12–13.

    Google Scholar 

  • Hoke, T. H., Wheeler, S. B., Lynd, K., Green, M. S., Razafindravony, B. H., Rasamihajamanana, E., & Blumenthal, P. D. (2012). Community-based provision of injectable contraceptives in Madagascar: ‘Task shifting’ to expand access to injectable contraceptives. Health Policy and Planning, 27(1), 52–59.

    Article  PubMed  Google Scholar 

  • Huber, D. H., & Khan, A. R. (1979). Contraceptive distribution in Bangladesh villages: The initial impact. Studies in Family Planning, 10, 246–253.

    Article  PubMed  CAS  Google Scholar 

  • Huber, D. H., Saeedi, N., & Samadi, A. K. (2010). Achieving success with family planning in rural Afghanistan. Bulletin of the World Health Organization, 88(3), 227–231.

    Article  PubMed  Google Scholar 

  • Huston, P. (1992). Motherhood by choice: Pioneers in women’s health and family planning (p. 161). New York: International Planned Parenthood Federation.

    Google Scholar 

  • Hutin, Y. J., Hauri, A. M., & Armstrong, G. L. (2003). Use of injections in healthcare settings worldwide, 2000: Literature review and regional estimates. British Medical Journal, 327(7423), 1075.

    Article  PubMed  Google Scholar 

  • ICF Macro. (2011). MEASURE DHS STATcompiler. Available at: http://www.statcompiler.com. Accessed 10 June 2012.

  • Janowitz, B., Stanback, J., & Boyer, B. (2012). Task sharing in family planning. Studies in Family Planning, 43(1), 57–62.

    Article  PubMed  Google Scholar 

  • Kane, A., Lloyd, J., Zaffran, M., Simonsen, L., & Kane, M. (1999). Transmission of hepatitis B, hepatitis C and human immuno-deficiency viruses through unsafe injections in the developing world: Model-based regional estimates. Bulletin of the World Health Organization, 77, 801–807.

    PubMed  CAS  Google Scholar 

  • Katz, K., Ngalande, R., Jackson, E., Kachale, F., & Mhango, C. (2010). Evaluation of community-based distribution of DMPA by Health Surveillance Assistants in Malawi. Final report. FHI 360. Research Triangle Park.

    Google Scholar 

  • Kaunitz, A. M., & Grimes, D. A. (2011). Removing the black box warning for depot nedroxyprogesterone acetate. Contraception, 84, 212–213.

    Article  PubMed  Google Scholar 

  • Kaunitz, A. M., Arias, R., & McClung, M. (2008). Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception, 77(2), 67.

    Article  PubMed  CAS  Google Scholar 

  • Keith, B. M. (2011). Home-based administration of depo-subQ provera 104™ in the Uniject™ injection system: A literature review. Seattle: PATH.

    Google Scholar 

  • Krueger, K., Akol, A., Wamala, P., & Brunie, A. (2011). Scaling up community provision of injectables through the public sector in Uganda. Studies in Family Planning, 42(2), 117–124.

    Article  PubMed  Google Scholar 

  • Leon, F. (2000). Utilization of DMPA and other operations research solutions in Peru. Lima: Population Council.

    Google Scholar 

  • Malarcher, S., Meirik, O., Lebetkin, E., Shah, I., Spieler, J., & Stanback, J. (2011). Provision of DMPA by community health workers: What the evidence shows. Contraception, 83, 495–503.

    Article  PubMed  Google Scholar 

  • McCarraher, D. (2000). Informe final. Administracion de Depo Provera a traves de asistentes voluntaries y personal del Centro de Salud CIES – El Alto. Unpublished project report. Family Health International, Durham, NC, USA.

    Google Scholar 

  • McPake, B., & Mensah, K. (2008). Task shifting in health care in resource-poor countries. The Lancet, 372(9642), 870–871.

    Article  Google Scholar 

  • Mushfiq, H., & Aitken, I. (2011). Scaling up community health worker provision of Depo‐Provera as part of a broader birth spacing program. Presentation at 2011 International Conference on Family Planning, Dakar, Senegal.

    Google Scholar 

  • Olawo, A. A., Washika, E., Gitonga, J., Malonza, I., & Manyonyi, K. (2011). Task sharing in reproductive health: Community-based distribution of depot medroxyprogesteroine acetate in Kenya: Findings from a pilot project in Tharaka District. Presentation at 2011 International Conference on Family Planning, Dakar, Senegal.

    Google Scholar 

  • Phillips, J. F., Greene, W., & Jackson, E. (1999). Lessons from community-based distribution of family planning in Africa. New York: Population Council.

    Google Scholar 

  • Population Reference Bureau. (2008). Family planning worldwide data sheet. Washington, DC: Population Reference Bureau.

    Google Scholar 

  • Population Reference Bureau. (2011). World population data sheet. Washington, DC: Population Reference Bureau.

    Google Scholar 

  • Prabhakaran, S., & Sweet, A. (2012). Self-administration of subcutaneous depot medroxyprogesterone acetate for contraception: Feasibility and acceptability. Contraception, 85(5), 453–457.

    Article  PubMed  CAS  Google Scholar 

  • Ramirez, L. (2008). Introduction of a training program for the delivery of Depo-Provera® by community-based providers from the Ministry of Public Health in Guatemala. Unpublished project report 2008. Final Report. Guatemala City, Guatemala: Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva.

    Google Scholar 

  • Reproductive Health Supplies Coalition. (2011). RH interchange. Available from: http://rhi.rhsupplies.org. Accessed 18 Dec 2011.

  • Rogers, E. M. (1962). Diffusion of innovations. Glencoe: Free Press.

    Google Scholar 

  • Simonsen, L., Kane, A., Lloyd, J., Zaffran, M., & Kane, M. (1999). Unsafe injections in the developing world and transmission of blood-borne pathogens: A review. Bulletin of the World Health Organization, 77(10), 789–800.

    PubMed  CAS  Google Scholar 

  • Stanback, J., Otterness, C., Bekiita, M., Nakayiza, O., & Mbonye, A. K. (2011). Injected with controversy: Sales and administration of injectable contraceptives in drug shops in Uganda. International Perspectives on Sexual and Reproductive Health, 37(1), 24–29.

    Article  PubMed  Google Scholar 

  • Stanback, J., Mbonye, A., & Bekiita, M. (2007). Contraceptive injections by community health workers in Uganda: A non-randomized trial. Bulletin of the World Health Organization, 85, 768–773.

    Article  PubMed  Google Scholar 

  • United Nations. (2011). The millennium development goals report 2011. New York: Department of Economic and Social Affairs.

    Google Scholar 

  • WHO, Department of Reproductive Health and Research. (2012). Hormonal contraception and HIV: Technical statement. http://whqlibdoc.who.int/hq/2012/WHO_RHR_12.08_eng.pdf

  • World Health Organization. (2007). Task shifting to tackle health worker shortages. Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization. (2010). Medical eligibility criteria for contraceptive use (4th ed., p. 51). Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization (WHO). (2006). The world health report 2006: Working together for health. Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization (WHO), UNICEF, UNFPA, World Bank. (2010). Trends in maternal mortality: 1990 to 2008: Estimates. Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization. (2012). WHO recommendations: Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: WHO.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John Stanback Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Stanback, J., Miller, R. (2014). Radical Common Sense: Community Provision of Injectable Contraception in Africa. In: Kulczycki, A. (eds) Critical Issues in Reproductive Health. The Springer Series on Demographic Methods and Population Analysis, vol 33. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6722-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-6722-5_13

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-6721-8

  • Online ISBN: 978-94-007-6722-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics