“A cup of tea with our CBD agent…”: community provision of injectable contraceptives in Kenya is safe and feasible

Background: In rural areas of Kenya, where the majority of the population lives, contraceptive use remains low compared with that in urban areas (37% vs. 47%). Inadequate access to family planning services in rural areas is partly due to fewer health facilities and the shortage of health care workers. Community-based access to injectable contraceptives can improve access for rural populations and expand the range of contraceptive methods available. Our pilot project sought to generate local evidence on safety, feasibility, and acceptability of the provision of injectable depot medroxyprogesterone acetate (DMPA) by community health workers (CHWs).

Design: We trained 31 CHWs to provide injectable DMPA in addition to pills and condoms. Data were collected on family planning clients served by CHWs as well as those who received services from health facilities from August 2009 to September 2010. Service statistics were collected from 3 health facilities in the CHW service catchment area.

Results: In the 12-month study period, CHWs reached 1,210 women with family planning services including referrals for long-acting and permanent methods. Family planning use in the pilot sites for all methods increased an estimated fivefold, from 9% in facilities to 46% when facilities and CHWs were combined (32% for CHWs and 14% for facilities). The majority (69%) of clients served by CHWs chose DMPA. No client reported any signs of infection at the injection site nor did any CHW report needlestick injuries or other adverse events. The re-injection rate was 68% at the third visit, which compares favorably with other DMPA continuation studies. Two main reasons given for discontinuing were change of residence and temporary separation from spouse.

Conclusion: Community-based provision of DMPA along with other contraceptive methods increased the use of family planning and method choice during the study period. Injectable contraception provided by trained CHWs is a safe, acceptable, and feasible service delivery option in Kenya.