Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC.

While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women's contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of "ever discontinuing". However, these variables became non-significant when controlling for resupply issues. Women's self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women's choices and preferences towards successful contraceptive trajectories in fragile health systems. Plain Language Summary: In countries with insufficient access to health facilities, such as the D. R. Congo, the provision of contraceptives through campaigns implemented in community settings is a commonly used strategy to increase the number of contraceptive users. However, the long-term trajectories of campaign clients are not often examined, and it is unclear whether these events can be an effective way to support women's choices and preferences when it comes to using, switching or stopping a contraceptive method. Our study looks at the contraceptive trajectories of 883 women who obtained a method during a community event to see whether they were still using that a modern contraceptive method 3 and 6 months later. Almost a third of the women discontinued at some point in that period, with much higher discontinuation rates for monthly pills and injectable contraceptives. While some individual characteristics (marital status, desired number of children, experienced side-effects) influenced discontinuation risk, the most important factor was the woman's ability to resupply her method. Implant removal was also much lower than expected and this suggested difficulties in accessing existing family planning services. Our findings indicate that campaigns are still too disconnected from existing family planning services to successfully support women's contraceptive choices in the long run. [ABSTRACT FROM AUTHOR]