BACKGROUND Efforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs). METHODS This paper reports on results of the impact of a randomized cluster trial of CHA deployment on contraceptive uptake among 3078 baseline and 2551 endline women of reproductive age residing in 50 intervention and 51 comparison villages in Tanzania. Qualitative data were collected to broaden understanding of method preference, reasons for choice, and factors that explain non-use. RESULTS Regression difference-in-differences results show that doorstep provision of oral contraceptive pills and condoms was associated with a null effect on modern contraceptive uptake [p = 0.822; CI 0.857; 1.229]. Discussions suggest that expanding geographic access without efforts to improve spousal and social support, respect preference for injectable contraceptives, and address perceived risk of side-effects offset the benefits of adopting contraceptives provided by community-based services. CONCLUSIONS The results of this study demonstrate that increasing access to services does not necessarily catalyze contraceptive use as method choice and spousal dynamics are key components of demand for contraception. Findings attest to the importance of strategies that respond to the climate of demand. TRIAL REGISTRATION Controlled-Trial.com ISRCTN96819844. Retrospectively registered on 29.03.2012.

中文翻译：

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在坦桑尼亚农村地区，将以社区为基础的口服避孕药和避孕套分布添加到一组随机的初级卫生保健干预措施中。

背景技术在非洲农村地区扩大获得计划生育服务的努力通常集中在社区卫生代理（CHA）的部署上。方法本文报道了在坦桑尼亚的50个干预村和51个比较村居住的3078名基线和2551名育龄终点妇女中，CHA部署随机分组试验对避孕药具摄取影响的结果。收集定性数据以拓宽对方法偏爱，选择原因和解释不使用因素的理解。结果回归差异结果表明，在门口提供口服避孕药和避孕套对现代避孕药的摄取没有影响[p = 0.822; CI 0.857；1.229]。讨论表明，不加努力改善配偶和社会支持的情况下，扩大地理获取范围，尊重对注射用避孕药的偏爱，并解决人们认为的副作用风险，这抵消了采用社区服务提供的避孕药的好处。结论这项研究的结果表明，获得更多服务并不一定能促进避孕药具的使用，因为方法选择和配偶动力学是避孕需求的关键组成部分。研究结果证明了应对需求环境的战略的重要性。试用注册Controled-Trial.com ISRCTN96819844。追溯注册于2012年3月29日。结论这项研究的结果表明，获得更多服务并不一定能促进避孕药具的使用，因为方法选择和配偶动力学是避孕需求的关键组成部分。研究结果证明了应对需求环境的战略的重要性。试用注册Controled-Trial.com ISRCTN96819844。追溯注册于2012年3月29日。结论这项研究的结果表明，获得更多服务并不一定能促进避孕药具的使用，因为方法选择和配偶动力学是避孕需求的关键组成部分。研究结果证明了应对需求环境的战略的重要性。试用注册Controled-Trial.com ISRCTN96819844。追溯注册于2012年3月29日。