Mozambique maintains a high total fertility rate that increased from 5.5 in 2003 to 5.9 in 2011, with the highest levels of fertility found in rural areas and among the poorest and least educated women. Since the implementation of family planning interventions in 1980, Mozambique has made notable progress in increasing awareness and knowledge of family planning, yet the most recent Demographic & Health Survey shows that only 11.3% of married women 15-49 years old use modern methods of contraception. This is a similar level compared to the 2003 DHS (11.7%), demonstrating no progress in modern contraceptive prevalence between 2003 and 2011. The fertility control choices for women are often limited by an inability to access health facilities and lack of preferred contraceptive methods at those facilities. Therefore it is not surprising that there is a high unmet need (29.9%) for contraceptives in Mozambique.
Despite significant strides to improve family planning in Mozambique, access is still limited. In July 2010, with the Family Planning Strategy 2010-2014, the Mozambique Ministry of Health approved the revitalization of the Agente Polivalente Elementar (APE) Program, as well as the use of traditional birth attendants (TBAs) to mobilize the community for increased utilization of family planning methods.
The project described in this report is the first to test a model for community-based distribution of DMPA in Mozambique and to our knowledge the first in the world to test community-based distribution of DMPA with TBAs. From 2014-2015, under leadership of the Mozambican Society of Obstetricians and Gynecologists and with technical support from the Bixby Center for Population, Health, and Sustainability at the University of California, Berkeley, Pathfinder International implemented a pilot study on the distribution of DMPA by both APEs and TBAs.