Community-Based Distribution of DMPA: The Matlab Project, Bangladesh

In 1975, the government of Bangladesh, in collaboration with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), initiated community-based distribution (CBD) of condoms and oral contraceptives to 150 villages in the Matlab subdistrict. The injectable contraceptive depot medroxyprogesterone acetate (DMPA or Depo-Provera) was made available in only six villages to assess its effect on the program. In 1977, the program was modified to make DMPA available in all participating villages and to improve the training and supervision of local providers - changes that substantially increased contraceptive acceptance and almost doubled the one-year contraceptive continuation rate. By early 1979, DMPA had replaced oral contraceptives as the most popular method, accounting for roughly half of all contraceptive use. CBD of contraceptives was successfully expanded to the Abhoynagar and Sirajganj subdistricts in 1984, more than doubling the regions' contraceptive use, in general, and increasing injectable use, in particular, from 0.1 percent to 25 percent. CBD of contraceptives was further expanded to eight more subdistricts in 1993. Despite some flaws in provision by CBD workers, surveys found better counseling, accessibility, and client satisfaction in regions where CBD of injectable contraceptives was available.

FHI 360