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Injectable Contraceptives: The Best Shot for Women in Mozambique

In rural Mozambique, asking a woman to make frequent trips to a health facility seeking services such as contraception is asking a lot. For many, that’s hours of walking, and the closest clinic might not be open or have her preferred method in stock. Others have never heard of or taken any form of contraception (contraceptive prevalence is only 12%).

But what if they were offered a more practical alternative, one that fit their needs and preferences? A woman could report to a nearby clinic for an injection that would protect her for three months with a 0.2 percent failure rate (with perfect use). Would she be interested in injectable contraception? Would she come back after three months for her next injection?

And more broadly, could distribution of injectable contraceptives at the community-level increase contraceptive prevalence and reduce the high unmet need for family planning?

We teamed up with USAID, the Mozambican Society of Obstetricians and Gynecologists, and UC Berkeley’s Bixby Center to find out.

In February of last year, we designed a study to explore the effectiveness of using two groups of community health workers—Agentes Polivalentes Elementares and traditional birth attendants—to administer depot-medroxyprogesterone acetate, commonly known as DEPO.

I recently presented our study findings alongside Ndola Prata of the Bixby Center at an event held on May 26, 2015 in Washington, D.C.

The study assessed the safety and feasibility of a community-based distribution program of depo in the Montepuez and Chiure districts in Cabo Delgado Province.

A total of 1,432 women enrolled in the study and received the first injection from the trained providers (either Agentes Polivalentes Elementares and traditional birth attendants). This group of women was surveyed again after 13 weeks when they returned for their second injection, and again after six months when they returned for their third.

Of the total women enrolled in the study and received the first injection, 1,242 responded to the 13-week questionnaire. That’s a 96% response rate! The study had a 81.1% continuation rate overall.

For many of the women, this was their first time they had used a contraceptive method.

In the end, the study findings show that depo can be administered safely and effectively by both Agentes Polivalentes Elementares and traditional birth attendants. And it’s our recommendation that it should be.

The findings underscore the demand for contraceptive services and the need to improve access to injectable contraceptives among rural women in northern Mozambique.

Policymakers and program planners should take this study as proof that community-based distribution of injectables is a viable option—safe and feasible—and accepted by women.

Mozambique study


To learn more about this study,
please download the Study Brief or the Full Report