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 sustained use of family planning 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 (continuation, switching, abandonment) and the factors associated with ever discontinuing contraceptive use in the first six months following a campaign. Contrary to most pilot studies, campaign clients were not provided with additional support, besides baseline counseling, to continue using the method they received, and could only rely on resources of the existing local health system. Almost a third (28.9%) of all women discontinued using modern contraception during the study period, with much higher discontinuation rates for short-acting methods (29.8% for pills and up to 64.0% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher OR for “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 short-acting methods highlighted the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system, which hinders their capacity to act as a gateway into long-term contraceptive use.