Pressing global health concerns, such as population growth and reproductive health issues, including family planning, demand timely, innovative solutions to respond to urgent needs. In developing countries, particularly in sub-Saharan Africa, access to family planning services is limited, especially in rural areas.

In a 2007-2009 pilot study, Bixby Center researchers demonstrated that community-based reproductive health agents (CBRHAs) are acceptable distributors of the injectable contraceptive depot medroxyprogesterone (DMPA) in Ethiopia. The community-based distribution (CBD) of DMPA increased access in rural communities, where unmet need is greatest, yet questions remained about sustainability and scale up. In a current study, researchers are testing the feasibility of a model to scale up a family planning intervention that incorporates CBD and social marketing of DMPA in Tigray, Ethiopia, by training CBRHAs to act as community marketers of DMPA, thereby mitigating the distribution and financing challenges that community-based programs face.

Through a pilot study from 2007-2009, researchers at the Bixby Center demonstrated that community-based reproductive health agents (CBRHAs) are acceptable distributors of the injectable contraceptive depot medroxyprogesterone (DMPA) in Ethiopia. These results aided the WHO in their decision to support task-shifting and community-based distribution (CBD) of DMPA. However, sustaining CBD of DMPA without burdening the public health system remains a global health challenge.

This project will serve to increase access to DMPA and reduce the high unmet need for family planning in rural areas of Ethiopia by incorporating private sector strategies, like social marketing, into existing CBD. The Bixby Center is using this study to explore the marginal costs and benefits, scalability, and sustainability of combining social marketing and existing CBD of DMPA.

In September 2011, the Bixby Center, along with the Women’s Association of Tigray (WAT), Mekelle University, and DKT-Ethiopia, started a three-year longitudinal study to scale up CBD of DMPA by CBRHAs in Tigray, Ethiopia. This study is conducted with the support of the Tigray Regional Health Bureau and funding from the Joffe Charitable Trust.