Expanding Community-Based Access to Injectables (CBA2I)

Thirty-five million women worldwide use injectable contraception to prevent pregnancy, and this number is projected to grow. In sub-Saharan Africa, more than one-third of women who use modern contraceptive methods opt for injectable contraception, making it the most widely-used modern method in the region. Injectable contraceptives appeal to the many women who seek a family planning method that is effective and convenient and can be used discreetly.

Many countries report high levels of unmet need for injectable contraceptives, despite their popularity. This is largely due to critical shortages in the health care workforce in 57 countries. In Africa alone, 36 countries face a dire shortage of doctors, nurses and midwives. Authorizing and training a wider range of health care providers -- including community health workers (CHWs) -- to administer injectable contraceptives can improve access to this method, expand contraceptive choice, reduce unmet need for family planning in hard-to-reach areas and alleviate shortages in the health care workforce.

Programs in more than a dozen countries in Asia, Latin America and Africa have demonstrated that appropriately trained community health workers can safely and effectively provide injectable contraceptives. In June 2009, the World Health Organization hosted a technical consultation on expanding access to injectable contraceptives. Global experts examined the scientific evidence on CHWs providing this service. The consultation concluded that appropriately trained CHWs can provide injectable contraceptives safely and effectively and that this approach is acceptable to women. The consultation also concluded that there is sufficient evidence to support the expansion of CHWs providing injectable contraception.

Selected Materials

Community-Based Provision of Injectable Contraceptives in Madagascar: 'Task Shifting' to Expand Access to Injectable Contraceptives (2011, Health Policy Plan)

Expanding Community-Based Access to Injectable Contraception: Materials for Action (2011)

Introducing Community-Based Distribution (CBD) of Injectable Contraceptives: Experiences and Outcomes from a Pilot Project in Tharaka District, Eastern Province of Kenya (2011)

Scaling Up Community Provision of Injectables through the Public Sector in Uganda (2011, Stud Fam Plan)

Community-Based Health Workers Can Safely and Effectively Administer Injectable Contraceptives: Conclusions from a Technical Consultation (2010, Contraception)

Conclusions from a Technical Consultation: Community-Based Health Workers Can Safely and Effectively Administer Injectable Contraceptives (2010, PDF, 181 KB)

Job Aids for the Reinjection of Injectable Contraceptives (2010)

Provision of DMPA by Community Health Workers: What the Evidence Shows (2010, Contraception)

Community-Based Providers in Rural Guatemala Can Provide the Injectable Contraceptive DMPA Safely (2009)

Provision of Injectable Contraception Services through Community-Based Distribution: Implementation Handbook (2008)

Safety, Feasibility, and Acceptability of Community-Based Distribution (CBD) of Depot Medroxy Progesterone Acetate (DMPA) in Madagascar (2008, PDF, 1.75 MB)