Significance
Introduction
Methods
MSI’s LARC Expansion Intervention
Channel/intervention | Description |
---|---|
Static clinic | Located in urban areas Competitively priced Income generated from clinics located in wealthier areas subsidizes clinics in urban slums and/or mobile outreach units Serves as a base for training and logistics to support mobile outreach units, social franchisees, and community-based distributors |
Mobile outreach | Visit communities with limited access to modern FP methods, such as rural villages and urban slums Provide free or subsidized FP services Pre-visit demand generation activities are conducted in partnership with local health care workers Typical team includes mid-level healthcare providers Operate from tents, vehicles or at government buildings Team may visit government clinics and complement the short-term methods provided |
Social franchising of private sector providers | Partner with existing private health care providers, predominantly in small towns and urban/peri-urban slums Enables rapid scale up of access to quality FP and reproductive health services |
Marie Stopes Ladies | Semi-urban areas Trained nurses and midwives working in the community to provide LARCs Data only included for Madagascar |
Task sharing | Non-physician providers trained to provide clinical procedures otherwise restricted to higher level cadres, for example insertion and removal of implants and IUDs by nurses and midwives Enabled MSI to increase the number of service providers and FP procedures in rural and peri-urban areas |
Alternative financing mechanisms | Aims to increase access to FP among clients who may otherwise be unable to afford services Paper or electronic vouchers (sent via SMS) for a particular service or range of services Public–private partnership: contracting local government authority outreach provision Working with health insurance schemes and development of community-based health insurance schemes |
Demand generation | Use of local media; e.g., radio spots Education and awareness raising through community health workers and satisfied clients Roadshows Paper-based flyers and posters |
Service Delivery Approaches
Task Sharing Initiative
Demand Creation Approaches
Ensuring Quality
Study Methods and Procedures
Findings
Service Provision of LARC in 14 Countries
Region | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
---|---|---|---|---|---|---|---|
Implants
| |||||||
East and Southern Africa | 77,409 | 171,422 | 241,431 | 359,503 | 625,603 | 750,458 | 1,018,360 |
West Africa | 2632 | 20,855 | 49,276 | 75,348 | 127,588 | 217,343 | 316,206 |
Total implants | 80,041 | 192,277 | 290,707 | 434,851 | 753,191 | 967,801 | 1,334,566 |
IUDs
| |||||||
East and Southern Africa | 66,354 | 83,316 | 138,744 | 141,633 | 183,257 | 219,557 | 285,181 |
West Africa | 3486 | 11,518 | 21,364 | 27,741 | 43,301 | 76,061 | 83,829 |
Total IUDs | 69,840 | 94,834 | 160,108 | 169,374 | 226,558 | 295,618 | 369,010 |
Total LARCs
| |||||||
East and Southern Africa | 143,763 | 254,738 | 380,175 | 501,136 | 808,860 | 970,015 | 1,303,541 |
West Africa | 6118 | 32,373 | 70,640 | 103,089 | 170,889 | 293,404 | 400,035 |
Total | 149,881 | 287,111 | 450,815 | 604,225 | 979,749 | 1,263,419 | 1,703,576 |
Socio-Demographic Characteristics of LARC Clients
All countries | East and Southern Africa | West Africa | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Ethiopia, Kenya, Madagascar, Malawi, Tanzania, Uganda, Zambia, Zimbabwe | Burkina Faso, Ghana, Mali, Nigeria, Senegal, Sierra Leone | |||||||||||
LARC users % (n = 3816) | Implant users % (n = 3214) | IUD users % (n = 602) |
P value | LARC users % (n = 1831) | Implant users % (n = 1548) | IUD users % (n = 283) |
P value | LARC users % (n = 1985) | Implant users % (n = 1666) | IUD users % (n = 319) |
P value | |
Age group
| ||||||||||||
15–24 | 37 | 39 | 21 | <0.01 | 39 | 42 | 24 | <0.01 | 29 | 32 | 10 | <0.01 |
25–34 | 45 | 44 | 50 | 45 | 44 | 53 | 45 | 46 | 40 | |||
35+ | 17 | 15 | 28 | 15 | 14 | 23 | 24 | 20 | 49 | |||
Unknown | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | |||
Parity
| ||||||||||||
None | 8 | 8 | 10 | 0.06 | 9 | 8 | 12 | 0.122 | 6 | 6 | 2 | <0.01 |
1–2 | 42 | 43 | 36 | 46 | 46 | 41 | 31 | 33 | 17 | |||
3–4 | 31 | 31 | 31 | 31 | 31 | 31 | 31 | 31 | 32 | |||
5+ | 19 | 19 | 23 | 15 | 15 | 16 | 32 | 29 | 48 | |||
Unknown | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | |||
Education
| ||||||||||||
None/some primary | 42 | 43 | 40 | 0.03 | 38 | 39 | 34 | 0.05 | 55 | 54 | 62 | 0.01 |
Primary/some secondary | 39 | 39 | 35 | 43 | 43 | 41 | 26 | 28 | 16 | |||
Completed secondary | 17 | 16 | 24 | 17 | 16 | 24 | 18 | 18 | 22 | |||
Unknown | 1 | 1 | 1 | 2 | 2 | 2 | 1 | 1 | 1 | |||
Marital status
| ||||||||||||
Single | 13 | 13 | 12 | 0.44 | 15 | 14 | 15 | 0.4 | 9 | 10 | 4 | 0.05 |
Married/living with partner | 84 | 83 | 86 | 82 | 82 | 84 | 88 | 87 | 93 | |||
Divorced/widowed/separated | 3 | 3 | 2 | 3 | 4 | 2 | 2 | 2 | 3 | |||
Declines to answer | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||
Location type
| ||||||||||||
Urban | 30 | 28 | 41 | <0.01 | 29 | 26 | 42 | <0.01 | 34 | 34 | 38 | 0.07 |
Rural | 56 | 58 | 44 | 58 | 61 | 45 | 50 | 51 | 41 | |||
Peri-urban | 14 | 14 | 15 | 13 | 13 | 13 | 16 | 15 | 21 |
Comparison to Demographic Health Survey Datasets
Adoption of Contraception and Switching from Short-Term Methods
Region | Overall | East and Southern Africa | West Africa | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
All countries | Ethiopia, Kenya, Madagascar, Malawi, Tanzania, Uganda, Zambia, Zimbabwe | Burkina Faso, Ghana, Mali, Nigeria, Senegal, Sierra Leone | ||||||||||
LARC users % (n = 3816) | Implant users % (n = 3214) | IUD users % (n = 602) |
P value | LARC users % (n = 1831) | Implant users % (n = 1548) | IUD users % (n = 283) |
P value | LARC users % (n = 1985) | Implant users % (n = 1666) | IUD users % (n = 319) |
P value | |
Adopters
| ||||||||||||
% of women who had not used FP in the previous 3 months | 46 | 47 | 44 | 0.05 | 42 | 42 | 41 | 0.07 | 59 | 60 | 55 | 0.63 |
Switchers
| ||||||||||||
% of women who switched from a short-term to a long-term FP method | 46 | 46 | 47 | 0.85 | 50 | 50 | 50 | 0.80 | 34 | 34 | 36 | 0.28 |
Socio-Demographics of LARC Users by Service Delivery Channel
All countries | East and Southern Africa | West Africa | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Ethiopia, Kenya, Madagascar, Malawi, Tanzania, Uganda, Zambia, Zimbabwe | Burkina Faso, Ghana, Mali, Nigeria, Senegal, Sierra Leone | |||||||||||
Outreach % (n = 2455) | Social Franchise Clinics % (n = 651) | Static clinics % (n = 587) |
P value | Outreach % (n = 1172) | Social Franchise Clinics % (n = 292) | Static clinics % (n = 244) |
P value | Outreach % (n = 1283) | Social Franchise Clinics % (n = 359) | Static clinics % (n = 343) |
P value | |
Age group
| ||||||||||||
15-24 | 36 | 36 | 39 | 0.83 | 40 | 34 | 39 | 0.49 | 26 | 41 | 42 | <0.01 |
Extreme poverty
| ||||||||||||
Living on <$1.25 a day or multidimensionally poor | 44 | 30 | 13 | <0.01 | 49 | 31 | 12 | <0.01 | 30 | 27 | 18 | 0.89 |
Education
| ||||||||||||
Incomplete primary education | 44 | 54 | 20 | <0.01 | 40 | 54 | 18 | <0.01 | 56 | 53 | 43 | 0.29 |
Location
| ||||||||||||
Rural | 71 | 24 | 2 | <0.01 | 77 | 24 | 2 | <0.01 | 57 | 26 | 5 | <0.01 |