Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges

Kwete, Dieudonné; Binanga, Arsene; Mukaba, Thibaut; Nemuandjare, Théophile; Mbadu, Muanda Fidèle; Kyungu, Marie-Thérèse; Sutton, Perri S.; Bertrand, Jane T.

doi:10.9745/ghsp-d-17-00346

Cited by 38 publications

(39 citation statements)

References 13 publications

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“…In Masisi, North Kivu, a 2013 assessment found that none of the 26 assessed public health facilities had a health worker trained to provide adolescent-friendly services; participants in focus group discussions stated that adolescent women were less likely than adult women to access contraceptive services [7]. This is consistent with other studies that also show that adolescent-friendly SRH services were limited nationwide [13,14].…”

Section: Introductionsupporting

confidence: 75%

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

Casey

Gallagher

Kakesa³

et al. 2020

PLoS Med

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Background Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15-24 in the health zones served by the partners' programs. Methods and findings The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July-August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15-49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15-24 who reported ever having sex: 326 adolescents (15-19 years) and 696 young women (20-24 years), 31.7% (95% confidence interval [CI] 29.5-34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method.

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Section: Introductionsupporting

confidence: 75%

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

Casey

Gallagher

Kakesa³

et al. 2020

PLoS Med

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“…DMPA-SC is still relatively scarce in Kinshasa (available in only 27.8% of pharmacies and health facilities) [3] and, even then, at prices that many women cannot afford. The major social marketing program provides DMPA-SC but uses its own personnel (“bees”) to administer it [21] . Will local health centers allow women to purchase doses of DMPA-SC for home use without charging them the client inscription fee?…”

Section: Discussionmentioning

confidence: 99%

An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa

et al. 2018

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ObjectivesGiven the promise of DMPA-SC to increase community-level access to modern contraception in developing countries, we conducted an observational study to assess the acceptability and feasibility of DMPA-SC self-injection among women in Kinshasa, Democratic Republic of the Congo, and of medical/nursing (M/N) students as instructors for self-injection.Study designWomen who selected DMPA-SC at a community outreach event adjacent to a health center were interviewed upon acceptance (baseline) and then 3, 6 and 12 months later.ResultsOf 850 clients selecting DMPA-SC at baseline, 640 (75.3%) opted for self-injection over being injected by the M/N students for reasons of convenience and personal agency. Among these 640 self-injectors, 47.5% were anxious at baseline (for fear of needles or injecting incorrectly). Over 80% reported feeling very ready after training, confident that they knew how to self-inject and confident that they would remember the next injection date. By 3 months, 97% described it as easy. Half (54%) experienced side effects, mainly menstrual irregularities, the main reason for discontinuation. At 6-month follow-up, self-injectors cited effectiveness and ease of use as positive elements, though one quarter reported side effects. Their impressions of M/N students as instructors were highly positive.ConclusionsWhere DMPA-SC was free and easily accessible, the majority of women interested in DMPA-SC opted to learn self-injection. The M/N students performed well in instructing women to self-inject. Clients were highly satisfied with the services received, yet many did not recognize their student status, possibly because outreach occurred near a health facility. Once told, clients remained very favorable, suggesting strong motivation to receive their preferred contraceptive free, whoever the provider.Implication statementThis study provides additional evidence on the acceptability and the feasibility of the self-injection of DMPA-SC by users from a resource-limited setting.

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“…Finally, the information gathered through the SDP survey was cross-sectional data and did not provide a comprehensive picture of the everchanging supply environment in Kinshasa. Most of the supply chain is managed by multiple donors and implementing organizations which procure and distribute commodities in parallel to national system supply chain channels [62]. This allows for a rapidly changing supply chain environment in which it is difficult to obtain comprehensive information regarding possible sources of contraceptive services.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Spatial Access and Modern Contraceptive Use: Is Proximity to a Healthcare Facility a Determinant of Use Among Women in Kinshasa, DRC?

Babazadeh

Hernandez

Anglewicz

et al. 2020

Preprint

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Background: Spatial access has a direct effect on health service utilization in many settings. While, all elements of access are usually affected by service delivery points and client characteristics. Distance to facility has proven to affect family planning service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay to observe any association between an increased distance of health facilities and health service utilization. This study to analyze the significance of proximity to family planning (FP) services, as well as service availability and quality of family planning services in Kinshasa. Methods: We used a pool of four rounds of facility- and population-based survey data in Kinshasa. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Discussion: Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are among the strong barriers for women in Kinshasa not to use modern contraceptives. Our analysis shows that proximity to quality services does not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusion: This study indicates that proximity to facilities does not necessarily equate proximity to methods, nor does it necessarily enable current users or women with an unmet need (potential contraceptive users) to easily obtain services for their method of choice. This study notes that other barriers to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.

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Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges

Cited by 38 publications

References 13 publications

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa

The Relationship Between Spatial Access and Modern Contraceptive Use: Is Proximity to a Healthcare Facility a Determinant of Use Among Women in Kinshasa, DRC?

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