Abstract
BackgroundThis study was conducted to test the acceptability and utilization of family planning benefits cards (FPBCs) as incentives to increase family planning uptake among youth living in urban slums in Uganda.MethodsWe conducted a one-year pilot study with two sub-studies on acceptability and utilization of FPBCs. The acceptability study utilized a quantitative cross-sectional design and was part of a baseline household survey while the utilization study was a primary analysis of claims and clinic data. We performed descriptive analyses and analyses of the association between different variables using binary logistic regression.ResultsThe acceptability study included 280 eligible females. The majority were married (52%), Christian (87%), and aged 20 and above (84%). Acceptability of the program was high (93%). Seventy-two percent of females used the card at least once to access reproductive health services. Twenty-seven percent of female users discontinued family planning and 14% changed family planning methods during the study. Female users of short-term contraceptive methods were 11 times more likely to discontinue use of FPBCs compared to those who used long-term methods (adjusted OR = 10.9, P = 0.011). Participants in professional/managerial employment were 30 times more likely to discontinue compared to the unemployed (adjusted OR = 30.3, P = 0.015). Participants of parity equal to two were 89% less likely to discontinue use of FPBCs compared to those of parity equal to zero (adjusted OR = 0.1, P = 0.019).ConclusionFamily planning benefits cards, deployed as incentives to increase uptake of family planning, exhibited high acceptability and utilization by youth in urban slums in Uganda. There was evidence that use of short-term contraception methods, professional employment, and lower parity were associated with discontinuation of modern family planning methods after initial enrolment.Trial registrationMUREC1/7 No. 10/05–17. Registered 19th, July 2017.
Highlights
This study was conducted to test the acceptability and utilization of family planning benefits cards (FPBCs) as incentives to increase family planning uptake among youth living in urban slums in Uganda
We reviewed the participant utilization data to assess the proportion of participants that changed contraceptive methods and/or those that discontinued the use of contraceptive methods in the six months period
The results shown that acceptability of the FPBC program was higher among married women compared to never married women (54% vs. 32%, P = 0.023)
Summary
This study was conducted to test the acceptability and utilization of family planning benefits cards (FPBCs) as incentives to increase family planning uptake among youth living in urban slums in Uganda. Despite the high knowledge and awareness of modern contraceptive methods (90%), utilization remains low due to low levels of education, lack of knowledge of the side effects of different contraceptive methods, and prohibitive cultural, social and religious norms [5, 7, 8]. The Government of Uganda has pledged to increase uptake of modern contraception to 50% and reduce the unmet need to 10% by increasing access to family planning information, targeting youth, and addressing the social and cultural misconceptions about contraception [2]. With support from the World Health Organization (WHO), the government is implementing youth friendly corners—designated spots for youth support—at health facilities to increase uptake of sexual and reproductive health services, including contraception [6]. The early results from this program suggest an increase in the proportion of youth with access to contraception, especially among informal workers such as waitresses and hair dressers [6, 9, 10]
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