Evaluation of natural family planning programmes in Liberia and Zambia

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Abstract
Summary: 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 women-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.