1. Increasing Uptake of Long Acting Reversible Family Planning Methods in Zambia Meeting the Family Planning Demand to Achieve MDGs Kigali, March 2010

2. page 2 Zambia context High and rising fertility: TFR increased from 5.9 to 6.2 Generalized HIV epidemic High unmet need for FP Shortage of qualified medical personnel Limited contraceptive choice due to –HIV burden –Limited MCH provider time, RH commitment/competency –Space, equipment & commodity gaps –Policies regarding provider cadres & FP service provision

3. page 3 LARM Clients Served Number of Clients

4. page 4 Results In the first 16 months, the program served 40,977 women with a long-term method of their choice (34% chose the IUD) 1,690 clients served with other methods 4 out of 10 clients served were not previously using any FP method 9% rural Very low discontinuation rates (2.9% among implant clients & 1% IUD clients) Lowest cost per CYP among 14 country programs supported by the same grant ($13)

5. page 5 Methodology Seconding competent, dedicated LARM providers to 20 high volume sites in 4 provinces Integrating demand creation with service delivery Piloting post-partum IUD services Providing significant post-training support & monitoring for LARM-trained providers Equipment to aide service delivery in low resource setting (headlamps, buckets w/ taps, insertion sets)

6. page 6 Provider Rynn Ngoma conducts a “sensitization talk” with rural women in Eastern province using SFH’s LTM flipchart--developed based on in-depth interviews w/ satisfied LARM users

7. page 7 PPIUD Clients Served Number of Clients

8. page 8 Lessons Seconding providers who serve as dedicated LARM champions can be a cost-effective strategy to increase LARM uptake Post-partum IUD is a viable contraceptive option in the Zambian context In a low LARM use context, providers require significant supervised practical experience & support to move from “LARM trained” to “LARM competent” Provider attitude and commitment are at least as important as clinical skills

9. Next Steps Raise funds for service delivery beyond June 2010 Expand coverage Integrate e.g. neonatal circumcision Partner with MOH to sustain national-level commitment to and uptake of LARM josselyn@sfh.org.zm page 9