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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Gwatkin, D. R. (1979). Political will and family planning. Population and Development Review, 5(1), 29–59.
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.
Hirve, S. (2005). Injectables as a choice – Evidence-based lesson. Indian Journal of Medical Ethics, 11(1), 12–13.
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.
Huber, D. H., & Khan, A. R. (1979). Contraceptive distribution in Bangladesh villages: The initial impact. Studies in Family Planning, 10, 246–253.
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.
Huston, P. (1992). Motherhood by choice: Pioneers in women’s health and family planning (p. 161). New York: International Planned Parenthood Federation.
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.
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.
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.
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.
Kaunitz, A. M., & Grimes, D. A. (2011). Removing the black box warning for depot nedroxyprogesterone acetate. Contraception, 84, 212–213.
Kaunitz, A. M., Arias, R., & McClung, M. (2008). Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception, 77(2), 67.
Keith, B. M. (2011). Home-based administration of depo-subQ provera 104™ in the Uniject™ injection system: A literature review. Seattle: PATH.
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.
Leon, F. (2000). Utilization of DMPA and other operations research solutions in Peru. Lima: Population Council.
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.
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.
McPake, B., & Mensah, K. (2008). Task shifting in health care in resource-poor countries. The Lancet, 372(9642), 870–871.
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.
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.
Phillips, J. F., Greene, W., & Jackson, E. (1999). Lessons from community-based distribution of family planning in Africa. New York: Population Council.
Population Reference Bureau. (2008). Family planning worldwide data sheet. Washington, DC: Population Reference Bureau.
Population Reference Bureau. (2011). World population data sheet. Washington, DC: Population Reference Bureau.
Prabhakaran, S., & Sweet, A. (2012). Self-administration of subcutaneous depot medroxyprogesterone acetate for contraception: Feasibility and acceptability. Contraception, 85(5), 453–457.
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.
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.
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.
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.
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.
United Nations. (2011). The millennium development goals report 2011. New York: Department of Economic and Social Affairs.
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.
World Health Organization. (2010). Medical eligibility criteria for contraceptive use (4th ed., p. 51). Geneva: World Health Organization.
World Health Organization (WHO). (2006). The world health report 2006: Working together for health. Geneva: World Health Organization.
World Health Organization (WHO), UNICEF, UNFPA, World Bank. (2010). Trends in maternal mortality: 1990 to 2008: Estimates. Geneva: World Health Organization.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights 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)