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

Introduction 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. Methods 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. Results 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. Conclusion 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.