Family planning, operations research; final narrative report

Contractor"s final report covers the period 10/78-10/81 and focuses on determining the project"s effect on contraceptive use. Rural health promoters in four areas in the state of Boyaca were trained to distribute the drugs and collect data on women aged 15-44 -- their number of living children, desire for more children, current use of contraceptives, and source of contraceptive supplies. Two groups of 3,000 families each received monthly household delivery of oral contraceptives; in two other groups persons interested in family planning (FP) were referred to a health post or hospital (as had traditionally been done). A comparison of 1979 and 1981 survey data--before and after service delivery--shows that contraceptive use more than doubled in all project areas over the 2-year period, primarily to space births. Boyaca shifted from a low use rate to an average rate for rural areas in Colombia. In the groups that received household delivery of oral contraceptives, a great increase in the use of orals was achieved, while in the referral groups, use of IUD"s and female sterilization increased. Surprisingly, the greatest increase in use of effective methods was in one of the two referral groups and not in a household distribution group. Because it was impossible for the project to utilize a strict experimental design, data analysis cannot explain this finding. Possibly the training program led promoters to feel that FP had great importance, encouraging them to increase FP referrals over previous levels. Another unexpected finding was that in two of the four groups the percentage of women using inefficent methods increased. Nonetheless, the project has proven that rural health promoters, given training and the support of health authorities, can distribute contraceptives and increase contraceptive use. As a result, Bolivia"s Ministry of Health has authorized health centers to delegate FP activities to health promoters. There is still an unmet need for FP services: 1981 survey data show that about 50% of exposed women who desired no more children were not using any contraceptive method and that about 17% were using inefficient methods.