_MoadLW Clical seriaes and commwai'y-based_ _dIsr*bulon_ 17 percent each), or the distributor (13 percent) as the primary source. Among users of DepoProvera (n= 14), two-thirds cited the hospital, one-third a clinic.

In sum, the clinics and pharmacies played the major supply role in Matadi, even for the contraceptives available from community distributors.

# **_5. Knowkdge_** _of_ **_and Contact with_** _PRODEF distributors_

On the 1989 followup survey, respondents were asked about the PRODEF program in particular. Among married women, 29 percent recognized the name "PRODEF" and virtually all of this group associated the name with family planning. Eight percent knew a community worker for family planning (presumably the distributor) and all of these could identify the person by name. However, only three percent of married women had purchased contraceptives from this person.

# _6. Observaions_ **_RegarVing_** _Contraceptive Prevalence in_ **_Matd_** _as of 1989_

While the percentage of couples using a modem method increased over time in Matadi, the percentage using traditional methods decreased. The percentages in 1981 vs. 1989 using withdrawal dropped from 33 to 16 percent, while abstinence decreased from 14 to 7 percent; rhythm on the other hand remained fairly constant at 3-6 percent over the three studies.

In short, the patterns of contraceptive use in Matadi suggest a gradual substitution of modern for traditional methods. The percentage using ANY method has changed relatively litde over this 8 year period, varying from 52-57 percent. While some might argue that there was litde real change, it is generally recognized that the effectiveness of modern contraceptives is in fact higher than that of withdrawal and rhythm.

Analysis of the Matadi experience would be greatly enhanced by the existence of a comparison group, which would have allowed for an assessment of what would have happened in the absence of any FP intervention. However, given the difficulty of identifying a "similar" population and the unacceptable option of denying family planning services to such a population for the purposes of research, one must instead use the available data from Matadi to assess the relative contribution of different service providers to "success" in this city.

The situation is more clear-cut for the period 1981-83 than for 1984-89, because the only major change in service delivery during the earlier period involved the implementation of PRODEF activities. The change in prevalence from 4 to 17 percent during that period reflected the important contribution of the PRODEF program to achieving a major increase in the use of modern contraceptive methods.

By contrast, during the period 1984-89, PRODEF continued to function through 6-9 dinics (the exact number varying over time) and 25-30 distributors. In addition, services were established/reinforced in the six PSND/AZBEF facilities, and tubal ligation continued to be available. The data on source of contraceptives as of 1989 reflect a diversity of providers, the choice of which was related to the method used. The service statistics from PRODEF vs. PSND/AZBEF clinics indicate that both delivered a fairly constant volume of contraceptives to