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J Biosoc Sci. 1993 Apr;25(2):249-58.

Evaluation of natural family planning programmes in Liberia and Zambia.

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Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland.


Studies to evaluate use-effectiveness and cost-effectiveness of natural family planning (NFP) were conducted in Liberia and Zambia. The Liberian programme provided uni-purpose NFP services to 1055 clients mainly in rural areas; the Zambian programme provided NFP services integrated with MCH to 2709 clients predominantly in urban areas. The one-year life table continuation and unplanned pregnancy rates were 78.9 and 4.3 per 100 woman-years in Liberia, compared to 71.2 and 8.9 in Zambia. However, high rates of loss to follow-up mandate caution in interpretation of these results, especially in Zambia. More women progressed to autonomous NFP use in Liberia (58%) than in Zambia (35.3%). However, programme costs per couple-year protection were lower in Zambia (US$25.7) than in Liberia (US$47.1). Costs per couple-year protection were higher during learning than autonomy, and declined over time. These studies suggest that NFP programmes can achieve acceptable use- and cost-effectiveness in Africa.


A team evaluated the use-effectiveness and cost-effectiveness of natural family planning (NFP) programs in Liberia and Zambia, both of which focused on sympothermal and ovulation methods. Accounting records were used to conduct the cost-effectiveness evaluation. Most women accepted NFP to prevent pregnancy (82.6% in Liberia and 73.2% in Zambia). Women in Liberia were more likely to complete the learning phase and to progress to autonomous use than those in Zambia (58% vs. 35.3%; p .001). User characteristics which contributed greatly to NFP performance included breast feeding and delivery within 6 months of beginning NFP (p .001) and intention to space births (p .01). Program factors were number of teacher-client contacts/month for all users and mean duration of learning phase (p .001) (2.4 for Liberia vs. 1.2 for Zambia and 8.5 vs. 13.2, respectively). Discontinuations due to change of pregnancy intention and for personal reasons were essentially equal in both programs. Change of pregnancy intention was more common during the learning phase. Unplanned pregnancies were more common in Zambia than Liberia (8.9/100 woman-years vs. 4.3/100 woman/years; p .01). In fact, they were higher in Zambia than in Liberia during the learning and autonomous phases (8.1 vs. 3.7; p .01 and 10.6 vs. 4.6; p .01, respectively). The Zambian NFP program had higher 12-month total discontinuation rates than the Liberian NFP program (28.8 vs. 21.2; p .01). Slow implementation of a techer supervisory system in Zambia resulted in a high rate of loss to follow-up (36.7). In Liberia, this rate was 15.7. Higher client recruitment in Zambia contributed to lower program costs/couple years of protection (CYP) (US$25.7 vs. US$47.1 for Liberia). The costs/CYP were much lower during the autonomous phase than the learning phase in both programs and fell over time. These findings indicated that NFP programs can realize adequate use- and cost-effectiveness in Africa.

[Indexed for MEDLINE]

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