With support from the Planned Parenthood Association of Zambia (PPAZ), the center recruited and trained seven community-based distributors (CBDs) and six youth peer educators—male and female—to do outreach, provide contraceptives and condoms, as well as referrals to Palabana center for sexually transmitted infections (STIs), ante- and post-natal care and other health services. The incidence of infant and maternal death dropped significantly, they tell us, and the benefits of family planning were crystal clear to everyone.

“When PPAZ was here, we never ran out of supplies and our volunteers had working bicycles to reach families living farther away,” reported one village elder. The government has not maintained the level of support that PPAZ gave us. Our volunteers are not as motivated and several have drifted away.”

We soon discover that Palabana center has no contraceptives, save male and female condoms. They ran out of oral contraceptive pills—the most popular method—two months ago. Women are frustrated they can’t get their method of choice, we’re told. To make matters worse, Depo Provera, the injectable contraceptive, was pulled from the shelves six weeks ago by the Ministry of Health, following a lab technician’s sensational report that a vial tested positive for HIV when he ran it through a rapid HIV test. (Independent tests are ongoing and it is expected that the Minister of Health will soon lift the ban.  Meanwhile, one has to wonder whether the damage done can be reversed. Anecdotes of women and health care workers saying they won’t use Depo again are common.)

Later that day we travel to the Kazimva rural health center on the opposite side of town. The story is much the same. Just 12 kilometers beyond city limits—and on a far shorter dirt road where vestiges of this year’s flooding are apparent—the health center is also out of contraceptives. We meet with the remaining CBD agents, peer educators and the community’s traditional birth attendant who report that they ran out of contraceptive pills more than a month ago.

“We’ve had a communication breakdown with the district since PPAZ support ended. Our orders for pills and other contraceptives go unanswered and no one from the district has come to oversee our efforts,” comments a spry older woman wearing an oversized CBD t-shirt over her traditional Zambian chitenge. “We lost several volunteers when supplies began running out. It’s hard to continue doing this work when we have little to offer women and men. We have condoms but we ration them as we’re worried they, too, will run out. Couples are using condoms, but they complain about the smell. We’re seeing a rise in unplanned pregnancies in our community.”

One volunteer says she’s worried the accusations that Depo is laced with HIV are true, that it could be an American scheme to deliberately infect Africans with HIV/AIDS. The PPAZ program manager, George, who’s accompanied us here, assures her these allegations are false, that Depo is fine, rapid HIV tests are designed for human blood, and that the Ministry of Health will soon reverse the temporary ban. She smiles and nods in response, yet it’s hard to tell whether she’s really convinced.

Overall, during our week looking at the impact of U.S. assistance and policy in Zambia, we’ve heard consistently about contraceptive shortages around the country, in both rural and peri-urban communities as illustrated above. Last year, Zambia experienced three distinct stockouts of oral contraceptive pills. Many providers and advocates argue that not enough contraceptive supplies are coming into Zambia to meet growing demand. Also, they point out, Zambia’s procurement and logistics system for getting essential drugs and supplies is weak. USAID/Zambia is now investing heavily in this side of the equation (through its DELIVER and SCMS projects) and hopefully will coordinate with the government and other donor agencies to boost contraceptive shipments in the years ahead.

NOTE: The Planned Parenthood Association of Zambia (PPAZ), the leading SRH provider in the country, refused the terms of the Global Gag Rule (GGR) in 2001 and immediately felt the impact from the loss of U.S. assistance and donated contraceptives. PPAZ has had to curtail its programs significantly and has undergone a major downsizing since the GGR. PPAZ’s extensive CBD network—notably in Eastern Province—collapsed and neither the government nor another NGO has the capacity to fill this role. Their popular “Success” condom marketed to Zambia’s youthful population, no longer exists. Please see PAI’s documentary, Access Denied: U.S. Family Planning Restrictions in Zambia for more background on GGR impact in Zambia.