In the village of Soanierana in northeastern Madagascar, 20-year old Sandrinah Razanadrasoa lives with her husband and their two-year-old daughter. After speaking with her local community health volunteer (CHV), Benary Benasaina, Sandrinah learned that spacing her pregnancies was the healthiest option for her, her two-year-old daughter, and her future children. With Benary’s guidance on birth intervals, Sandrinah decided to use a family planning method to space her pregnancies. She chose an injectable contraceptive, known as Depo Provera, because, as she puts it, “my husband and I both agreed that we wanted to wait three years before having our second child. My husband supported my decision to start using a contraceptive.”

USAID works across Madagascar to train CHVs on life-saving and essential health interventions. Volunteers provide counseling to first-time users on available family planning options. In the past, women like Sandrinah, who decided to use an injectable family planning method, needed to travel to the nearest health facility to get the injection. Often, these facilities were far away, taking time and planning to make the visit. The distance and lack of familiarity resulted in other barriers, too, including requiring women to speak about sensitive topics with health workers they didn’t know and who may not be as trusted as their CHV.

But in 2018, with technical and financial support from USAID and its partners, Madagascar passed a national law allowing CHVs to administer injectable contraceptives. As CHVs are often the first and primary way that rural Malagasy women access health services, this policy increases access to family planning options in hard-to-reach areas. Njara Bert Marcelin, the Soanierana Village Head, remarked, “ever since the CHVs were allowed to provide Depo, women in our village have had better overall timing and spacing of pregnancies.”

From CHVs at the community level to effective policy at the national level, USAID is committed to strengthening options and opportunities for the health and well-being of women and their families. By strengthening in-country capacity and offering expanded access to voluntary family planning, USAID partners with countries like Madagascar on their Journey to Self-Reliance.

Sandrinah, her baby, and community health volunteers.

Photo Credit: Anne Daugherty

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