_10_ _Regina_ **_McNamara et al._** lower than in most of the other nine regions of Rwanda. This region is in the northern part of Rwanda; it was not affected by the civil unrest occurring during the life of the operations research project but educational and other developmental activities in the area were undoubtedly affected by the military actions of 1990.

The research was conducted in three noncontiguous communes, each with a population of about 30,000. Two, Kidaho and Gatonde, were experimental areas, and a third, Kinigi, served as a control. In Kidaho, 23 volunteers trained for the project provided information and clinic referrals and distributed contraceptives (condoms and spermicidal tablets, and resupply of oral contraceptives). In Gatonde, information and referrals by 23 trained volunteers were the only interventions. Routine services at the clinics continued in these areas as well as in Kinigi, which had no outreach activities.

A series of meetings among collaborating organizations and meetings with national and regional officials of ONAPO, NINISANTE, and MININTER were held at the project's start to make sure its objectives and procedures were clearly understood and supported. In the study area, existing clinic services and service statistics were reviewed and focus group discussions provided information for training and for the design of research instruments.

At the start of the project, family planning clients were about equal in numbers at the single clinic in each of the two experimental areas. The control area, Kinigi, had three service sites and almost twice the family planning clients. immediately after Abakangurambaga training in February 1988, increases in clinic attendance in Gatonde were of sufficient magnitude to cause the authorities to open a satellite facility in that commune. Clinic attendance in Kidaho increased also, though to a lesser extent. The community-based distribution of contraceptives, mainly condoms, in Kidaho accounted for little of the gains in contraceptive usage. Injectable contraceptives, available only in the clinics, were by far the method of choice in these communes, as in the country as a whole.

A survey of 1,363 randomly selected married women, aged 15 to 49, conducted in the study areas after 16 months of Abakangurarnbag **a** ctivity, verified trends that had been observed from service statistics. The contraceptive prevalence rate, as estimated in January 1988 for the three areas taken together, was 4.6 percent for modern methods. By June 1989, prevalence had risen to 13.9 percent. The survey in the Gatonde commune, which had not had distribution by the volunteers, found 2F.5 percent prevalence of modern methods, compared with the earlier estimate of 4.5 percent. Kidaho, where contraceptives were distributed, reported an increase from 2.3 percent to 6.4 percent, and the control area, which had a higher prevalence of 6.9 percent in 1988, increased to 7.4 percent in June 1989 (Figure 1).

Overall, affirmative replies to questions on desire to use contraception in the future were given by 70 percent of the women with one to three children who were not currently using. Sixty-three percent of the respondents with seven or more children, not currently using, indicated an intention to use in the future.

ONAPO and the ministries reacted quickly to the early evidence of positive effects of the volunteer activity on clinic services and set in motion a comparable national program before the operations research results were in. Rwanda's 'Global IEC Plan" was instituted in late 1988 and 17,000 Abakangurambaga vwere trained as family planning promoters, though not as community