This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.

Though the evidence base is weak, there are promising foundations for adolescent contraceptive interventions in nearly every region of the world. We offer recommendations for programmers and identify gaps in the evidence base to guide future research.

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This study examines current disparities in access to family planning services in developing countries with data drawn from 64 Demographic and Health Surveys conducted between 1994 and 2008. The percent of demand satisfied is used as a proxy measure for access to family planning. In all regions, married women aged 15-19 have greater difficulty than older women in meeting their need for contraceptive services. Inequities in the percent of demand satisfied among individuals of varying economic status, area of residence, and education are observed in all regions except Central Asia. These gaps are larger and more common in sub-Saharan Africa. Strategies that seek to increase contraceptive use rapidly without consideration for disadvantaged groups are likely to increase observed inequities in percent of demand satisfied in the short-term. Efforts to monitor progress toward the goals enumerated in 1994 at the International Conference on Population and Development and toward other development goals must go beyond global, regional, and national averages to address the needs of population groups that are at greatest risk of adverse health outcomes.