Understanding Barriers to Uptake of Long-Acting Reversible Contraception (LARC)

Policy Context

In Zimbabwe, high rates of unintended pregnancy often come with adverse consequences for women and families such as decreased education and employment opportunities. Long Acting Reversible Contraceptive (LARC) methods, including implants and intrauterine contraceptives, represent a currently underutilized approach to meeting women’s unmet need for contraception. However, less than three percent of women in Zimbabwe use LARC methods; major barriers to the uptake include lack of awareness and misconceptions among women, as well as inadequate or lack of provider training.

Research Design

This project evaluated the impact of a community-based intervention to increase LARC uptake in Population Services International, Zimbabwe (PSI/Z) clinics. The intervention was modeled after a similar program in Zambia that utilized hairdressers to educate women about female condoms. Hairdressers were randomly assigned to one of three groups and trained to discuss LARC methods with their clients. Administrative data from PSI/Z clinics were used to determine LARC uptake and new client visits. Researchers compared results from the different groups to determine the most effective method to increase LARC uptake, and design a full scale evaluation of that method.

Results and Policy Lessons

Over a three-month period, a total of 56 hairdressers from 18 salons were asked to discuss LARC methods with their clients and refer clients to a local Population Services International (PSI/Z) clinic. Hairdressers at salons in the intervention arm received a small token (supplies for their hair salon business) for successful referrals.

Hairdressers distributed a total of 206 women referral coupons that women could use to access services at a nearby PSI/Z clinic. Just over one in ten (11%) accessed services over the follow up period using these referral cards. A slightly larger proportion of women who visited salons in the intervention arm (hairdressers received an incentive for successful referrals) accessed contraceptive services as compared to women in the comparison arm (16 vs. 7%, p=0.07). There was tremendous heterogeneity in the frequency of referrals by specific hairdresser, ranging from 0 to 57. Preliminary analyses of qualitative interviews with hairdressers and women who visited the salons suggest the intervention was implemented with fidelity and women were receptive to the LARC messages delivered by hair dressers.