Community Health Volunteers Drive Informed Family Planning Decisions in Madagascar

July 6th, 2020 | Story


Georgine, 41, and her partner have two boys and three girls, all two years apart in age. For eight years, Georgine has been a family planning (FP) client of Soanette Razanadrasoa, the Community Health Volunteer (CHV) at the Andongozabe health hut in Andapa, in the northwestern Sava region of Madagascar. Georgine chose Depoprovera as her contraceptive method of choice, which she receives as an injection every three months. This has proven to be an effective method in helping the couple manage pregnancies. 

Given her age, Georgine wanted to avoid another pregnancy and the risks associated with it. She sought advice from Soanette about the appropriate contraceptive method for her case. “We decided to continue family planning because our family has reaped multiple benefits, especially economic ones. The interval between births has allowed me to contribute to our household income,” says Georgine. “I scrupulously apply the health advice of CHV Soanette who is competent in counseling mothers and monitoring the children’s health.”

Georgine’s story reveals her satisfaction with the FP services she receives and her knowledge of how to use FP effectively for her family, including resuming use of FP after giving birth. Too often, this is not the case: studies about the causes and consequences of contraceptive discontinuity among women of reproductive age generally show that one-third of women using modern contraception interrupt it after the first year of use, and the other two-thirds before the second year of use. 

The USAID Community Capacity for Health project in Madagascar supports nearly 10,000 CHVs to educate communities about reproductive health and provide local FP services. Soanette provides FP services to 107 women in the village, including young women aged 10-24. Program-supported basic health centers (CSB) conduct practical training courses and refresher sessions and provide local support to ensure that CHVs have strong technical knowledge and skills. The CHVs are also trained to offer long-acting reversible contraception (LARC) options, like IUDs and implants, and provide referrals to the CSBs or to intermittent mobile clinic services. During monthly meetings at the CSB, CHVs receive technical updates, submit monthly activity reports, and submit stock reports to ensure the availability of FP commodities. 

Soanette says that she and other CHVs have benefited from program supported-training on contraceptive methods, including condoms, cycle beads, contraceptive pills, LAM (a natural method of contraception based on exclusive breastfeeding during the first six months of the baby’s life), and Depoprovera and Sayana Press injections.

From my experience, there are essential conditions that maintain clients’ confidence in contraception, even if they switch methods over the years,” Soanette affirms.

According to her, these conditions are input availability, having comprehensive information on several choices of contraceptive methods according to age, sexual education that complements family planning services, ongoing counseling through home visits about methods or other health reasons, partner support in the choice of family planning.

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