An operations research project measured the impact and cost-effectiveness of two strategies for delivering family planning services in Bas Zaire: Supplying dispensaries and community distributors with contraceptives and at the same time undertaking an extengive outreach program, and supplying these sources but doing no outreach. Before the project began, only about 4-5 percent of urban women and 2-5 percent of rural women aged 15-44 who were living in union were using modern contraceptive methods. Within two years, this proportion had increased to 10-19 percent in four study areas. However, use of traditional methods decreased, suggesting that many women substituted modern methods for traditional ones. Prevalence in the areas that received outreach was only 2-3 percentage points higherthan that in areas that received no outreach. A cost-effectiveness analysis shows that the cost of providing one couple with a month of contraceptive protection was higher in the rural area than in the urban area. In addition, the cost per couple-month of protection was slightly higher when outreach was included.
Findings from a baseline survey conducted prior to the initiation of organized family planning efforts in one urban and one rural area of Bas Zaire reveal the widespread use of traditional methods and a surprisingly high level of knowledge of modern contraceptives. However, in the absence of a delivery system, use of the latter was extremely limited (4-5 percent of currently married women). The data reflect a deep-seated motivation for birth spacing, which is achieved primarily through withdrawal and abstinence. Of the variables tested as possible correlates, only economic status was related to use of both traditional and modern methods in the same direction. Use of a traditional method was largely determined by age of the youngest child and breastfeeding status. By contrast, use of a modern method was highest among women over 30 with higher levels of education and parity, who were not currently breastfeeding.
All use subject to http://about.jstor.org/terms rates were highest among users of the pill and lowest among users of foam. Among women who were no longer using their contraceptive method, the main reason given was that the woman had become pregnant (22 percent of urban women and 33 percent of rural residents).
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