Empowering Rural Malagasy Women with Modern Family Planning

{Photo credit: Fanja Saholiarisoa/MSH}Photo credit: Fanja Saholiarisoa/MSH

The US Agency for International Development (USAID) Mikolo Project is a five-year project led by Management Sciences for Health (MSH) focused on reducing maternal, infant, and child mortality in some of Madagascar’s hardest to reach communities by increasing access to community-based primary health care services and encouraging women of reproductive age to adopt healthy behaviors for themselves and their children.

One of Mikolo’s key efforts is to offer Malagasy women the option to use modern contraceptive methods. 

In the past nine months, the project provided contraceptives to 68,000 continuing users and 52,000 new users. The project offers women a range of contraceptive options, including injectables, which have proved to be the most popular.  Twenty percent of all female users of modern contraception in Madagascar choose injectables. 

The USAID Mikolo Project is currently introducing Sayana Press, a new injectable contraceptive that is both simple and safe to administer. Sayana Press, a low-dose formulation of the injectable contraceptive, Depo-Provera, can prevent pregnancy for up to three months after a single injection. 

The real innovation of Sayana Press is its ease of use. Unlike Depo-Provera, which a health care administrator must measure out and inject into muscular issue, Sayana Press comes in a single-use dispenser and is injected right below the skin’s surface, making it simple enough for a woman to administer to herself. These advantages make it a potentially transformative contraceptive method in regions where insufficient infrastructure and difficult geography isolate rural communities and limit transportation. The USAID Mikolo Project is training local community health volunteers (CHVs) to provide basic health services, with a special emphasis on maternal and child health and family planning.  Sayana Press is easy to use and requires minimal training, making it a great option for CHVs and the women they serve.

The USAID Mikolo Project has already trained 2,134 CHVs across eight health zones to use Depo Provera and is training 788 CHVs across three zones to provide Sayana Press. These volunteers have the potential to reach approximately 60,000 women each quarter and offer them a safe, effective, and discrete method to choose the size of their families and timing of their pregnancies. 

CHVs and the Malagasy women they serve are often unable to determine if they are pregnant when they are not menstruating. As a result, these women do not know if they should seek prenatal care or if they can begin contraceptive use.  After a pilot study to test the efficacy of training CHVs to administer pregnancy tests, USAID concluded that pregnancy tests will increase the demand for contraceptive services in Madagascar by 24 percent.  Therefore, Mikolo is currently scaling up this intervention across Madagascar to empower Malagasy women to take full control of their reproductive health.