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Increasing Access to Family Planning Services in Rural Mali Through Community-Based Distribution

Karen R. Katz, Caroline G. West, Fode Doumbia and Fatoumata Kane
International Family Planning Perspectives
Vol. 24, No. 3 (Sep., 1998), pp. 104-110
Published by: Guttmacher Institute
DOI: 10.2307/3038206
Stable URL:
Page Count: 7
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Increasing Access to Family Planning Services in Rural Mali Through Community-Based Distribution
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Context: Community-based contraceptive distribution (CBD) has been the subject of relatively few quantitative studies, despite the use of these programs in a number of areas where contraceptive prevalence is low. Methods: A CBD program was incorporated into a nongovernmental organization's primary health care system in two subdistricts in rural southern Mali. In two other subdistricts, information and education alone were provided by primary health care workers. A fifth subdistrict served as a control group. Contraceptive knowledge, attitudes and practices were measured prior to program implementation in a pretest survey of 2,994 women and men. After 18 months, a posttest survey of 2,551 women and men was conducted. Results: Women's knowledge of at least one modern contraceptive method was greater after the intervention than before for all three groups: 99% vs. 10% in the CBD group, 71% vs. 10% in the education-only group and 53% vs. 10% in the coontrol group. Women's curren use of a modern contraceptive method also increased, from 1% to 31% in the CBD group, from 1% to 10% in the education-only group, and from 2% to 14% in the control group. Oral contraceptives and spermicides were the most popular methods in the CBD group, while the pill accounted for almost all contraceptive use in the education-only and control groups. Similarly, men's ever-use of condoms increased from 9% to 35% in the CBD group and from 7% to 16% in the education-only group, compared with use levels of 6% vs. 10% in the control group. Conclusions: The CBD approach tested in rural Mali raised contraceptive knowledge and practice through use of an existing health care framework, and may be a model for those working to expand and improve family planning programs elsewhere in Africa.