# Task-shifting through community health workers: factors influencing access and utilization of modern family planning methods in Ziniaré, Burkina Faso

## TL;DR

This study explores how community health workers in rural Burkina Faso affect access to family planning, finding that while they improve awareness, contraceptive use did not significantly increase.

## Contribution

The study evaluates a task-shifting intervention using community health workers to expand family planning access in rural Burkina Faso.

## Key findings

- Contraceptive prevalence was 48% in the intervention group and 53% in the control group, with no statistically significant difference.
- Factors like being in a union, knowing more contraceptive methods, and discussing FP with a partner were associated with higher contraceptive use.
- Most women preferred facility-based FP services for confidentiality, and sociocultural barriers like stigma persisted.

## Abstract

Burkina Faso has expanded access to family planning (FP) with modern contraceptive use prevalence among married women reaching 32% in 2021. However, regional disparities persist, especially in rural Ziniaré district where unmet needs among married women remain high (20%). Barriers like stigma, limited youth-friendly services, and low contraceptive awareness hinder uptake. This study examined factors influencing modern FP use and explored the role of community health workers, Agents de Santé à Base Communautaire (ASBCs), a government-supported cadre trained and equipped to provide FP services at community level, within a task-shifting intervention. Understanding these factors is vital for strategies to expand equitable access and improve reproductive health in rural and peri-urban areas.

We conducted a cross-sectional comparative mixed-methods implementation study with quasi-experimental features, following TREND reporting guidelines, in Ziniaré district, in August 2024. The study included four intervention and three control communes. Intervention communes received an eight-month package for ASBCs that included FP training, provision of short-acting contraceptives (oral pills, subcutaneous DMPA, condoms), regular supportive supervision and structured performance monitoring. Control communes continued to provide routine, primarily facility-based FP services. Quantitative data were collected from 282 women aged 15–49 years (136 intervention, 146 control) using structured household questionnaires; analyses included descriptive statistics and multilevel logistic regression (p < 0.05). Qualitative data were obtained from 60 participants (men, ASBCs, facility managers) through semi-structured interviews.

Modern contraceptive prevalence was 48% in the intervention group and 53% in the control group, without statistical significance (OR = 0.68, 95% CI: 0.27–1.68, p = 0.4). Factors associated with higher contraceptive use included being in a union (OR = 21.3, p = 0.009), knowing more contraceptive methods (OR = 1.45, p < 0.001), and discussing FP with a partner (OR = 7.57, p < 0.001). Most women preferred obtaining FP services at health facilities for confidentiality (82% vs. 17% for community-based). Qualitative findings highlighted persistent sociocultural and religious barriers, including stigma and myths about sterility.

Despite ASBC-led task-shifting improving awareness, engagement, and access to FP services, the difference in contraceptive prevalence between intervention and control communes (48% vs. 53%, OR = 0.68, 95% CI: 0.27–1.68, p = 0.4) does not provide strong evidence of a measurable impact. The study was likely underpowered to detect this within the limited 8-month period. Strengthening community-based FP requires longer implementation, enhanced confidentiality, culturally sensitive strategies, education promotion, male engagement and continued ASBC support.