Community-Based Distribution of DMPA: The APROFAM Project, Guatemala

In 1995, the Guatemalan family planning association Asociación Pro-Bienestar de la Familia de Guatemala (APROFAM), in partnership with the Population Council, conducted operations research comparing acceptance and continuation rates between clinic provision and community-based provision of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA). The project provided community-based provision of DMPA to over 750 women in four districts. At 15 months, the continuation rate for clients of community-based distributors (CBDs) was 90 percent, which was identical to the clinic continuation rate. CBDs also achieved high acceptance and continuation rates among rural Mayan women, an important goal of the program. Follow-up of community-based distributors who had the most clients and who provided the most couple-years of protection noted that these successful CBDs tended to be women over 30 years old who were recognized as community leaders. Among all clients served by CBDs, only three infections were reported. Due to the success of this program, APROFAM expanded community-based distribution of DMPA throughout the country to all of its 22 districts of operation. All community-based promoters in APROFAM's rural development program are trained to provide DMPA services. Furthermore, CBDs now distribute not only progestinonly DMPA, but also the monthly combined (progestin and estrogen) injectable Cyclofem.

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