Context

Community-based contraceptive distribution (CBD) has been the subject of relatively few quantitative studies, despite the use of these programs in a number of areas where contraceptive prevalence is low.

Methods

A CBD program was incorporated into a nongovernmental organization's primary health care system in two subdistricts in rural southern Mali. In two other subdistricts, information and education alone were provided by primary health care workers. A fifth subdistrict served as a control group. Contraceptive knowledge, attitudes and practices were measured prior to program implementation in a pretest survey of 2,994 women and men. After 18 months, a posttest survey of 2,551 women and men was conducted.

Results

Women's knowledge of at least one modern contraceptive method was greater after the intervention than before for all three groups: 99% vs. 10% in the CBD group, 71% vs. 10% in the education-only group and 53% vs. 10% in the control group. Women's current use of a modern contraceptive method also increased, from 1% to 31% in the CBD group, from 1% to 10% in the education-only group, and from 2% to 14% in the control group. Oral contraceptives and spermicides were the most popular methods in the CBD group, while the pill accounted for almost all contraceptive use in the education-only and control groups. Similarly, men's ever-use of condoms increased from 9% to 35% in the CBD group and from 7% to 16% in the education-only group, compared with use levels of 6% vs. 10% in the control group.

Conclusions

The CBD approach tested in rural Mali raised contraceptive knowledge and practice through use of an existing health care framework, and may be a model for those working to expand and improve family planning programs elsewhere in Africa.

International Family Planning Perspectives, 1998, 24(3):104-110