Abstract
BackgroundThe 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The Urban Reproductive Health Initiative (URHI) was a Bill & Melinda Gates Foundation funded program designed to help contribute to these goals in urban areas in India, Kenya, Nigeria, and Senegal. URHI implemented a range of country-specific demand and supply side interventions, with supply interventions generally focused on improved service quality, provider training, outreach to patients, and commodity stock management. This study uses data collected by the Measurement, Learning & Evaluation (MLE) Project to examine the effectiveness of these supply-side interventions by considering URHI’s influence on the number of family planning clients at health facilities over a four-year period in Kenya, Nigeria, and Senegal.MethodsThe analysis used facility audits and provider surveys. Principal-components analysis was used to create country-specific program exposure variables for health facilities. Fixed-effects regression was used to determine whether family planning uptake increased at facilities with higher exposure. Outcomes of interest were the number of new family planning acceptors and the total number of family planning clients per reproductive health care provider in the last year.ResultsHigher program component scores were associated with an increase in new family planning acceptors per provider in Kenya (β = 18, 95% CI = 7–29), Nigeria (β = 14, 95% CI = 8–20), and Senegal (β = 7, 95% CI = 3–12). Higher scores were also associated with more family planning clients per provider in Kenya (β = 31, 95% CI = 7–56) and Nigeria (β = 26, 95% CI = 15–38), but not in Senegal.ConclusionsSupply-side interventions have increased the number of new family planning acceptors at facilities in urban Nigeria, Kenya, and Senegal and the overall number of clients in urban Nigeria and Kenya. While tailoring to the local environment, programs seeking to increase family planning use should include components to improve availability and quality of family planning services, which are part of a rights-based approach to family planning programming.
Highlights
The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020
The average number of new acceptors per reproductive health staff member increased over the four-year evaluation period from 99 to 168 in Kenya, from 21 to 51 in Nigeria, and from 51 to 65 in Senegal
With a onepoint increase in program score, the mean number of Family planning (FP) users per provider in the last 12 months increased by 31 in Kenya and 26 in Nigeria (Table 4). This analysis finds that Urban Reproductive Health Initiative (URHI) program interventions at reproductive health care facilities in urban Nigeria, Kenya, and Senegal have led to increased contraceptive uptake and use at those facilities
Summary
The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The 2012 London Summit on Family Planning, known as the FP2020 Initiative, called for a range of global commitments to enable 120 million more women and adolescent girls to use modern contraceptives by 2020 [1]. Central to this goal is FP2020’s recognition of “the fundamental right of individuals to decide, freely. What little attention there has been has focused on quality and availability as supply-side interventions Most of this evidence has relied on data from population-based surveys or not covered urban Africa [6,7,8,9,10], the target area for this study. Findings on the relationships between facility improvements and contraceptive uptake are somewhat contradictory
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