E2A expands contraceptive choice in Burundi

After spending more than a decade mired in ethnic conflict, in 2006, the small, landlocked nation of Burundi began piecing itself back together again. Despite a return to peace, Burundi’s small size, dense population and general poverty continue to impede its development, straining natural resources, leaving 35 percent of children under the age five malnourished and contributing to a high maternal mortality rate of 500 deaths per 100,000 live births.

At this time, Burundi’s government is focusing on improving the country’s outlook through strengthened family planning programs that aim do two things by 2025: halve the country’s high fertility rate — from 6.4 to 3 children per woman — and ensure 40 percent of the population is using modern contraceptive methods, almost double the number of people using them now. 

To help the government meet these ambitious goals, E2A has been working with Pathfinder International’s USAID-funded Maternal and Child Health (MCH) Project to make it easier for women in Burundi’s Kayanza and Muyinga provinces — home to two of the largest and most vulnerable populations in the country — to access a range of contraceptives. The contraceptive options from which women in Burundi have historically chosen have been limited, particularly for long-acting methods. Injectable contraceptives (depo provera) have been the most popular and widespread long-acting contraceptive method.

Jadelle expansion

Offering more long-acting methods where they were not previously available enhances women’s right to choose from a range of contraceptive methods. With technical assistance from E2A, the MCH Project has been able to expand the provision of the long-acting, reversible contraceptive Implant called Jadelle in Kayanza and Muyinga. Jadelle is an implant which is 99 percent effective at preventing pregnancies for a period of five years. 

From January to June of this year, uptake of Jadelle rose sharply in both provinces — from virtually no acceptors to more than 5,800 new users in Muyinga and more than 2,900 in Kayanza. Jadelle acts similarly to injectables, but requires fewer visits to the health facility. Some clients have also reported favorably that Jadelle is a less invasive method than the intrauterine device because it is implanted in the arm.

Multifaceted E2A support

E2A worked with the Ministry of Health to develop and adopt a trainer’s guide that has been used to update providers’ skills in the provision of Jadelle. E2A also led a “training of trainers” course with clinicians from five provinces, including Kayanza and Muyinga. That training focused not only on competency-based skills for counseling that institutes voluntary informed choice of family planning methods, insertion and removal of Jadelle, and infection prevention, but also essential elements of effective health programming, such as planning, implementing, and monitoring and evaluating the contraceptive’s introduction. Those trainers then went on to train a cadre of service providers who now offer Jadelle at public sector health facilities or through mobile outreach services, an effective way of delivering contraceptive services to women who live far from a health center or have limited means for travel. 

Funding from E2A has also strengthened the clinic- and community-based provision of family planning interventions, supporting the MCH Project to build capacities in several areas, including:

• Training service providers to safely deliver a wide range of contraceptives, and ensure voluntary informed choice during counseling sessions.
• Strengthening referral linkages between community health workers and health facilities.  
• Engaging in supportive supervision to ensure family planning interventions are carried out as they should be. 
• Strengthening the logistics for procuring and delivering family planning commodities. 
• Integrating behavior-change interventions into the project’s family planning components. 

Advancing the right to choice

By expanding the contraceptive method mix, E2A has taken part in advancing Burundian women’s right to choose from a range of contraceptives. The expansion of Jadelle has allowed women in Kayanza and Muyinga provinces to better steer their own futures and think more seriously about planning a family. Without such choices, many women in Burundi are forced to give birth before they are ready, in a country where it is still all too common for women to die in childbirth.

Since the Jadelle expansion in Kayanza and Muyinga, the Ministry of Health has procured 100,000 Jadelle implants for national provision and is supporting several multipronged efforts to generate increased demand for the method. 

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