Free Pregnancy Testing Is Linked to Uptake of Hormonal Contraceptives

By Rosenberg, J. | International Perspectives on Sexual and Reproductive Health, March 2016 | Go to article overview

Free Pregnancy Testing Is Linked to Uptake of Hormonal Contraceptives


Rosenberg, J., International Perspectives on Sexual and Reproductive Health


Providing community health workers (CHWs) with pregnancy testing kits appears to be an effective way to increase their distribution of hormonal contraceptives, according to an evaluation of a 2013 intervention conducted in rural Madagascar. (1) Compared with CHWs in the study's control group, those in the study's intervention group--who received urine pregnancy tests to distribute without charge to women in their communities and training on how to use the tests--provided hormonal contraceptives (i.e., the injectable and the pill) to a greater average number of new clients per month during the four-month study period (3.1 vs. 2.5). In analyses by specific method, the difference by group was seen for distribution of the injectable, but not of the pill.

In Madagascar, CHWs are allowed to sell contraceptives to women living in rural areas, where access to other family planning providers is limited. Before providing a hormonal method, CHWs are supposed to confirm that the client is not pregnant. This is typically done using a six-question checklist; however, the checklist method has a high false-positive rate, which results in many eligible women being denied a hormonal method. To assess whether providing CHWs with free urine pregnancy testing kits increases distribution of hormonal contraceptives, researchers evaluated an intervention implemented in three regions of eastern Madagascar in 2013.

All practicing CHWs in the study regions were eligible to participate; however, the researchers excluded 48 in two hard-to-reach districts, as well as 36 with extremely high client caseloads, which resulted in a sample of 622. Within each region, half of participating CHWs were randomized to the intervention group and half to the control group. Intervention group CHWs each received a free supply of 50 pregnancy tests and training on how to use them, but were not specifically instructed to use the tests for the provision of hormonal contraceptives; all CHWs received training on how to collect family planning service data using a monthly reporting form. Data were collected from CHWs at baseline and for each of the four months following training, and were analyzed using descriptive and ordinary least-squares regression analyses.

At baseline, the majority of CHWs in the intervention and control groups were female (65% and 72%, respectively) and married (86% and 83%); for both groups, the mean age was 43. On average, CHWs lived a two-hour walk from the nearest health center and had to travel nearly 20 kilometers to replenish their supply of health products for resale. …

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Free Pregnancy Testing Is Linked to Uptake of Hormonal Contraceptives
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