Abstract
From 2001 to 2011, modern contraceptive prevalence in Uganda increased from 18% to 26%. However, modern method use, in particular use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs), remained low. In the 2011 Uganda Demographic and Health Survey, only 1 of 5 married women used a LARC or PM even though 34% indicated an unmet need for contraception. Between 2011 and 2014, a social franchise and family planning voucher program, supporting 400 private facilities to provide family planning counseling and broaden contraceptive choice by adding LARCs and PMs to the service mix, offered a voucher to enable poor women to access family planning services at franchised facilities. This study analyzes service trends and voucher client demographics and estimates the contribution of the program to increasing contraceptive prevalence in Uganda, using the Impact 2 model developed by Marie Stopes International. Between March 2011 and December 2014, 330,826 women received a family planning service using the voucher, of which 70% of voucher clients chose an implant and 25% chose an intrauterine device. The median age of voucher users was 28 years; 79% had no education or only a primary education; and 48% reported they were unemployed or a housewife. We estimated that by 2014, 280,000 of the approximately 8,600,000 women of reproductive age in Uganda were using a contraceptive method provided by the program and that 120,000 of the clients were "additional users" of contraception, contributing 1.4 percentage points to the national modern contraceptive prevalence rate. The combination of family planning vouchers and a franchise-based quality improvement initiative can leverage existing private health infrastructure to substantially expand family planning access and choice for disadvantaged populations and potentially improve contraceptive prevalence when scaled nationally.
Highlights
Global Health: Science and Practice 2017 | Volume 5 | Number 3long-acting reversible contraceptive (LARC) or permanent methods (PM).[1]
The 2011 Uganda Demographic and Health Survey (DHS) reported that intrauterine devices (IUDs) were used by less than 1% of married women even though 34% of married women indicated an unmet need for family planning services.[1]
Access to a broad method mix is associated with higher contraceptive continuation rates, and higher levels of contraceptive use are associated with reductions in maternal and neonatal mortality and morbidity, a key development goal in low- and middle-income countries (LMICs).[4,5]
Summary
LARC or PM.[1] The 2011 Uganda DHS reported that intrauterine devices (IUDs) were used by less than 1% of married women even though 34% of married women indicated an unmet need for family planning services.[1] High modern contraceptive prevalence is associated with improved maternal health outcomes and a range of positive social outcomes.[2,3]. Access to a broad method mix is associated with higher contraceptive continuation rates, and higher levels of contraceptive use are associated with reductions in maternal and neonatal mortality and morbidity, a key development goal in low- and middle-income countries (LMICs).[4,5] While the method mix has improved in many LMICs it remains skewed with short-acting modern contraceptives representing most of the observed increases in uptake in response to family planning program initiatives.[6,7] Significant inequities and disparities
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