Family planning components in community-based distribution projects: Risk/benefit considerations in the choice of methods

Modern contraceptive technologies such as combined oral contraceptives and intrauterine devices were developed in the late 1950s and introduced on a large scale in industrialized countries more than two decades ago. The inability of a health-service-based program to provide adequate family planning care demonstrated a need for family planning workers drawn from the community. This led to the development of Community Based Delivery (CBD) programs in which lay workers from the community use simplified procedures and provide family planning in a nonclinic setting. The chapter examines the health-related aspects of contraceptives used in CBD programs, especially with regard to the nature of the methods, safety considerations, simplified procedures needed to counsel and screen new clients, monitoring and support of users, and the requirements for supervision and referral. The consequences of family planning on health depend largely on the balance between contraceptive risks and benefits and the risks of childbearing.