Improving Access to Family Planning in Madagascar

{Photo credit: MSH}USAID Mikolo recently recognized 10 community health volunteers for completing their training in the use of pregnancy test kits.Photo credit: MSH

4,000 Madagascar Community Health Volunteers Learning to Use Pregnancy Test Kits

Although more married women in Madagascar are using modern contraceptives than ever before, their use among this group has stabilized at about 30 percent. In response, the USAID Mikolo Project is training 4,000 community health volunteers (CHVs) how to use pregnancy test kits—a pioneering strategy to help expand family planning in remote areas.

Before providing hormonal contraceptives, health workers must first know if a woman is pregnant. The test kits will speed up the process and help avert missed opportunities to provide access to family planning methods.

More than 2,000 CHVs have been trained since the end of May. USAID Mikolo recently recognized 10 CHVs for completing their training.

“This pregnancy test kit may be a means to increase the number of early antenatal consultations because women can be referred earlier if the test is positive,” said United States Ambassador Robert Yamate, who presided over the certificate ceremony on June 18. Also attending were Susan Sawhill Riley, Mission Director of the US Agency for International Development (USAID) in Madagascar, and Malagasy officials.

Local media widely covered the event.

USAID Mikolo, which is led by Management Sciences for Health (MSH), has called for a technical task force, including Madagascar’s Ministry of Public Health and technical and financial partners, to scale up the use of the pregnancy test kits.

In 2013, a study done by USAID’s Strengthening Health Outcomes through the Private Sector (SHOPS) project showed that providing pregnancy test kits to CHVs was helping to increase modern contraceptive use among potential clients. CHVs using the kits 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.

The research noted that missed opportunities could occur when women told the CHVs that they were not menstruating. The CHVs would assume these women were pregnant though their cessation of menstruation could have had other causes, such as illness, malnutrition, breastfeeding, or stress.

To further understand the potential benefits of CHVs’ use of pregnancy test kits, USAID Mikolo began conducting operations research in June 2015 in 20 communes in the Haute Matsiatra and Atsimo Andrefana regions to document the effect of pregnancy screening on women’s likelihood of attending antenatal care (ANC). The project anticipates an increase in the number of new family planning users among those with negative pregnancy test results, and more ANC visits among those with positive test results. CHVs will refer clients to health centers for ANC. The research ends in October 2015 and preliminary results will be ready by November.

The five-year project works to increase the use of community-based primary health care services and the adoption of healthy behaviors among women of reproductive age, children under the age of five, and infants in six of Madagascar’s 22 regions.