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_Overview offramiy_ **_planning_** _In_ **_Zaire_** Africa, the experiences of these two cities In Zaire-Matadi and Kananga-merit examination as case studies of family planning success in a francophone African society.

# II. Matadi: Clinical Services and Community-based Distribution

## A. Characteristics of the City and its Population

Matadi is the ninth largest city in Zaire, with a population of 139,000 in 1984 [2]. It is the only ocean port for the country, located in the region of Bas Zaire, 375 kilometers from Kinshasa by a well-travelled highway. As a key commercial link between the outside world and the capital city of Kinshasa, Matadi is more exposed to influences from the West than are many other cities within Zaire. Because of its proximity to the coast and several generations of Protestant and Catholic groups working in the area, Bas-Zaire is one of the most heavily christianized regions.

In addition, Bas Zaire retains some elements of a matrilineal kinship system. This may have some bearing on family planning, as was seen in a study of attitudes toward voluntary cessation of childbearing [14]. While there was still a desire for large families in Bas Zaire, the husband's family was less likely **t.** exert pressure for continued childbear,ng in this area than in other regions of the country. These and other factors may account for the fact that in one assessment of areas in sub-Saharan Africa most likely to accept modern family planning, the region of Bas Zaire was cited as one of the potentially receptive areas **_[15]._** A 1981 survey of women of reproductive age in Matadi indicated that 42 percent had attended some grade of secondary school; 68 percent reported they were able to read. The respondents were primarily Christian: Protestant (44 percent) or Catholic (43 percent). The mean age at first marriage was 17.5 years, and 10 percent of married women reported they were in polygynous marriages. Childbearing generally began before age 20 in this population, and by their mid-twenties, over 90 percent of the women had been pregnant at least once. Completed fertility was 7.8 among those 45-49 years old [11].

Prior to 1981 contraceptives were available in Matadi from two main sources: (1) private pharmacies, where they were prohibitively expensive, and (2) an AZBEF-supported clinic which offered services several days at week, but had periodic stockouts of certain contraceptives. In the early 1980s several local doctors went abroad for training in tubal ligation. This service was available through three facilities in Matadi by the mid-1980s (though a large number of the tubal ligations performed were for medical reasons, not "elective" for contraceptive purposes only). From 1985-89, the number of operations performed for the three facilities comabined ranged from 70-84 per year. With these services available, the prevalence of modern contraceptive methods in Matadi in 1981 was 4 percent [5].

Beginning in 1981 service delivery expanded through three mechanisms: (a) the PRODEF project, (b) a reinforcement of clinic-based facilities with the support of the national family planning program, and (c) the increased availability of tubal ligation. PRODEF was designed and implemented before the national family planning program officially began in 1983 and so played a catalytic role in family planning services in Matadi. Collectively these efforts resulted in the highest level of modern contraceptive use of any city in Zaire, and one of the highest reported