Abstract
BackgroundGrowing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care.MethodsThis exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated.ResultsThe case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue.ConclusionThe study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.
Highlights
Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care
The districts were selected based on the presence of ongoing social accountability projects focused on improving access to quality contraceptive services implemented by Reproductive Health Uganda
Case studies of each project are presented in narratives of how social accountability operated in the context of contraceptive care
Summary
Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care. Service level barriers to quality contraceptive services, such as inconvenient hours and long waiting times, inaccurate and incomprehensible information, disrespectful and discriminatory treatment by service providers, along with untrained health care providers, lack of supplies and informal fees, negatively affect women’s confidence in and use of contraceptive services, thereby limiting their ability to exercise their reproductive rights [11, 17, 24, 47, 50, 62]. Congestion in public facilities translate into overstretched staff and long waiting times that exacerbate opportunity costs and social risks [35, 56]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
