_Family Planning Success in lwo Cites in Zaire_ _8_ in a francophone African country. It is useful to view the activi.ies of Matadi in two phases, 1981-83 and 1984-89, first because prevalence data are available for 1981, 1983, and 1989; second, because it was after 1983 that the sources of service delivery other than PRODEF grew in importance in Matadi.

# B. 1981-83: **the PRODEF Project**

PRODEF stands for the Programme d'Education Familiale or Family Education Program, which was the name given to the original Bas Zaire operations research project under the auspices of the Communaute Baptiste du Zaire Ouest (CBZO, Baptist Community of West Zaire) with technical assistance from Tulane University. Our discussion in this paper concerns only the PRODEF activities in the city of Matadi. The original project also included a rural area of BasZaire and later extended to several other cities. In fact the name PRODEF became synonymous with all community-based distribution (CBD) of contraceptives in Zaire.

The main objectives of the original PRODEF/Matadi effort (1981-89) were to increase women's knowledge of modern contraceptive methods, to improve their attitudes toward family planning and to increase the percentage of married women of reproductive age who used modem contraceptive methods. The second phase (1984-89) provided the opportunity to evaluate the cultural acceptability of CBD in an urban setting and the long-term impact of family planning interventions on contraceptive prevalence in this area.

# **_1. Project_** _Design of PRODEF, Phase I_

The city of Matadi has three administrative districts. The majority of the population lives in the districts of Nzanza and Mvuzi, which have been the target areas studied in the three prevalence surveys to date. The third administrative district was excluded from the project (and thus from study) because it consisted of (a) well-placed administrative officials and business people who could afford to obtain services from other sources, and (b) a low income population similar to that found in Nzanza and Mvuzi, living in highly dispersed housing over a large, hilly terrain. It was felt that project resources would be more efficiently used if they were concentrated in the very densely populated areas of Nzanza and Mvuzi, rather than spread to this third administrative zone as well.

Within Nzanza and Mvuzi were a number of dispensaries, health posts and health centers. These facilities were managed by churches, government, parastatals, or private businesses. Their outpatient clinic services varied greatly; some were well-managed and well-supplied, while otheis were quite poor. PRODEF sought to add or upgrade family planning services alongside the ongoing clinic activities. In addition, PRODEF planned a test of the feasibility and effectiveness of community-based distribution (CBD) of contraceptives.

In Phase I, the target population was divided into two treatment groups ("zones") for the purposes of testing alternative strategies. In Zone A, the nurses in four government and churchoperated clinics were traired in family planning service delivery, and these clinics were supplied/resupplied with free contraceptives to sell to clients. In addition, an extensive outreach program was undertaken, consisting primarily of home visiting and the free household distribution