A decade of lifesaving care in Zambia

Luapula Province, Zambia—Samfya is a fishing town along the shores of Lake Bangweulu in Zambia’s Luapula Province. Women here often spend weeks on remote islands processing fish, their days shaped by the lake’s seasonal patterns. For them, every hour counts—time spent traveling to distant health facilities for family planning services means lost income and opportunity.

Emmanuel Chisapa, a husband and father of three, was moved by the long distances and winding queues women had to go through to access family planning services. The barriers were especially harsh for fishermen’s wives, adolescent girls, and young women, who often faced stigma at health facilities. Missed appointments led to unintended pregnancies, increasing maternal health risks, and limiting women’s ability to plan their futures.

“I saw too many women die from preventable complications,” Chisapa explains. “Some were just girls. My own mother was one of them. I couldn’t stand by and do nothing.” In 2011, driven by a deep passion for serving his community, particularly in addressing maternal health challenges, Chisapa started working as a community-based distributor (CBD). CBDs are specialized community health workers who focus specifically on distributing and counseling on family planning methods, while the broader category of community health workers includes various cadres working at the community level.

The challenges Chisapa witnessed reflect a broader national pattern. According to the FP2030 Indicator Summary Sheet: 2023 Measurement Report for Zambia, modern contraceptive use averted 720,000 unintended pregnancies and 760 maternal deaths nationwide, demonstrating the lifesaving potential when women are able to access and control their reproductive health choices. Yet almost 20 percent of married women in Zambia still have an unmet need for modern contraception, with barriers particularly affecting people with low incomes.

Against this backdrop, CBDs like Chisapa saw an opportunity to make an impact. Trained in comprehensive family planning counseling, these CBDs began introducing women to a different approach: self-injection with DMPA-SC (subcutaneous depot medroxyprogesterone acetate)—a three-month injectable contraceptive that women can administer themselves using a prefilled device.

This innovation has transformed reproductive health care access in Samfya. Women in this village no longer have to choose between their health and their livelihoods. Chisapa travels along shoreline communities, equipping women with the tools and confidence to take control of their reproductive health. Rather than being constrained by clinic schedules, stockouts, or long journeys, they can now administer their DMPA-SC injections at their convenience, between the morning’s catch and the evening market, seamlessly integrating health care into their daily routines.

“Women no longer walk for hours or wait in long queues,” says Chisapa. “They carry their doses with them, even on fishing trips, and inject when it’s time. They are happier, healthier, and more productive.”

This approach has transformed family planning from a logistical burden to an easily accessible and informed choice. It aligns perfectly with Samfya’s fishing-based livelihoods, reducing travel barriers and freeing clinic resources.

In line with Zambia’s commitment to universal health coverage and achieving its FP2030 goals, the government of Zambia worked with the PATH-led Injectables Access Collaborative (AC), in partnership with the Clinton Health Access Initiative, inSupply Health, Jhpiego, and JSI, to expand reproductive health access nationwide.

Over its eight-year span, the AC worked closely with the Ministry of Health to provide data-driven technical assistance, coordination, resources, and tools to ensure that women and girls have increased access to DMPA-SC and self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.

Supporting the government’s strategy to decentralize family planning services, the AC’s work in Zambia and a grant from the DMPA-SC Catalytic Opportunity Fund, enabled the training and mentoring of over 300 CBDs to deliver self-injection services at the community level. These CBDs have enabled hundreds of women in Samfya to self-inject confidently, providing take-home DMPA-SC devices that eliminate barriers such as long travel distances and clinic wait times.

The results speak to the program’s effectiveness: increased contraceptive uptake, improved continuation rates, and fewer unintended pregnancies. Clinics are less burdened, and women report greater autonomy and satisfaction with their care. Most importantly, integrating self-injection into Zambia’s national family planning strategy reflects the program’s success and the government’s commitment to innovative, women-centered solutions.

One of the women Chisapa trained, a young mother, shared her experience: “I used to miss my clinic days because I was on the islands drying fish. Now, I carry my dose with me. I feel in control, and I don’t have to choose between my work and my health.”

The success in Samfya is more than a local achievement—it’s a model for reproductive health innovation across Zambia. By addressing women’s realities and removing systemic barriers, the AC has made injectable contraception more accessible, sustainable, and woman centered.

As Monica Mutesa, Zambia’s AC Country Coordinator, puts it, “Our work ensures that no woman should have to choose between her livelihood and health. By bringing self-injection directly to communities, we’re giving Zambian women autonomy over their reproductive futures.”

Women are experiencing significant economic benefits. With fewer clinic visits, they have more time for income-generating activities, like farming during peak seasons. One woman describes the transformation:

“It helps us because we cannot manage on every reinjection date to come to the clinic and leave the work we have at home just to rush here to get contraception. When we miss the contraception date again, we are ridiculed and told to buy a pregnancy testing kit. This is where self-injecting is beneficial.”

Thanks to the tireless efforts of Chisapa and other CBDs, self-injection is also easing pressure on Luapula’s health system. As more women adopt this method, clinics are less congested, allowing health workers to focus on new clients and urgent care.

Luapula Province health leadership has fully embraced this shift, transitioning self-injection services to the community level. This aligns with Zambia’s broader strategy to decentralize care and reduce the burden on health workers.

As Tedson Saineti, Provincial Nursing Officer, explains, “The results speak for themselves—we are seeing more consistent contraceptive use, fewer missed appointments, and a reduction in unintended pregnancies. Most importantly, women who once struggled to access care now have full control over their family planning, anytime and anywhere. This is not just convenient—it’s transformative for maternal health outcomes across Luapula.”

With additional support from the DMPA-SC Catalytic Opportunity Fund, the AC project delivers a triple impact: supporting women’s independence, easing provider workload, and strengthening the health system.

“Self-injection is a game changer,” Saineti adds. “When women master self-injection, it reduces dependency on CBDs and facilities, creating a sustainable cycle of [independence].”

Back in Samfya, Emmanuel Chisapa continues his work along the shoreline communities, driven by the same determination that started this journey over a decade ago.

“Sometimes I skip meals to reach more women. Their safety and happiness are worth every sacrifice,” says Chisapa, indicating his commitment. “Training women to self-inject has given them control over their lives. They don’t miss appointments, and they [feel more secure about preventing] unwanted pregnancies.”