Pregnancy Tests Help Boost Family Planning in Madagascar
Vololona Razafimanantsaranirina Harivelo has been a community health volunteer (CHV) in the northeastern Malagasy village of Vohitsoa for more than five years. She has impacted the lives of more than 500 people in her community, providing maternal and child health services, including family planning.
Before providing hormonal contraceptives, health workers must first know if a woman is pregnant. But, instead of pregnancy, lack of menstruation could mean that a woman is breastfeeding, ill, malnourished, or experiencing stress. In addition, approximately 80 percent of the Malagasy population lives in remote areas, making repeat CHV visits to check up on menstruation schedules extremely difficult.
The US Agency for International Development’s Mikolo (USAID Mikolo) project, led by Management Sciences for Health, is helping avert missed opportunities for providing family planning by supporting local nongovernmental organizations (NGOs) to train CHVs, including Harivelo, in the use of urine pregnancy tests. At least 2,232 CHVs were trained from June to September 2015. USAID Mikolo works to increase the use of community-based primary health care services and the adoption of healthy behaviors among women of reproductive age and children under the age of five in six of Madagascar’s 22 regions.
In 2013, a pilot study commissioned by USAID/Madagascar showed that providing pregnancy tests to CHVs was helping to increase modern contraceptive use among potential clients. CHVs using the tests provided hormonal contraceptives to 24 percent more new clients during the four-month study than did the control group who relied on a checklist to rule out pregnancy. Madagascar is the first country to scale-up pregnancy test use by CHVs, according to the US Embassy.
Universal access to family planning services in Madagascar has the potential to reduce maternal mortality by about one-third, which would help reduce unintended pregnancies, abortions, and maternal and child deaths, according to the embassy.
The contraceptive prevalence rate in Madagascar—40 percent on average—has remained low for years, partly because of limited access to family planning, especially in rural areas. Harivelo, 50, understands that spacing pregnancies through contraceptive use can help prevent maternal and child deaths and that using pregnancy tests improves the quality of her services. Harivelo said:
Ever since I introduced pregnancy tests, I feel more confident in my recommendations. It is much easier to make decisions about counseling on contraceptive methods or referring the client to the health center for early antenatal care.
To further understand the potential benefits of CHVs’ use of pregnancy tests, USAID Mikolo began conducting operations research in 2015 to document the effect on family planning, as well as the likelihood of women attending antenatal care. Preliminary data analysis from Ambatondrazaka District, where Harivelo works, indicated that the number of new family planning users increased by 86 percent between June and September 2015 after CHVs introduced the pregnancy tests.
Given Madagascar’s history of strong CHV programs, health workers say the use of pregnancy tests has the potential to quickly increase modern contraceptive prevalence rates and use of antenatal care services in the country.