Radical Common Sense: Community Provision of Injectable Contraception in Africa

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.