Access To Family Planning Services Research Articles

Women's access to family planning and experiences of reproductive coercion during the COVID-19 lockdown in two districts of Uganda

BackgroundIn March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). MethodsWe conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. FindingsThe most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. InterpretationAn increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.

Family planning service availability and readiness assessment of primary health care facilities in Delta State, Nigeria: a mixed methods survey

BackgroundThe availability of contraceptives, family planning guidelines, and Information, Education, and Communication (IEC) materials can increase access to family planning services. This study assessed the availability of commodities and readiness of primary health care (PHC) facilities in Delta State to offer family planning services.MethodsA cross-sectional design with an explanatory mixed-method approach was used i.e., the authors first collected the quantitative data, and after preliminary analysis of quantitative information, the qualitative approach was utilised to gather data on the perspectives of 32 PHC facility managers and 6 reproductive health supervisors on factors affecting family planning service availability and readiness.ResultsTwenty-one (65.6%) of the PHC facilities surveyed offered at least five modern methods of family planning. Stock-outs of emergency contraceptives, implants, intra-uterine contraceptive device (IUCD), oral contraceptive pills (OCP), condoms, and injectables were observed in 31 (96.9%), 17 (53.1%), 13 (40.6%), 4 (12.5%), 2 (6.3%), and 1 (3.1%) of the facilities respectively. Eleven (34.4%) and 8 (25.0%) of the facilities had IEC materials and family planning guidelines, and contraceptive commodity checklists respectively. Seventeen (53.1%) of the facilities did not have complete records of family planning activities.ConclusionThis study shows that a significant proportion of PHC facilities had stock-outs of contraceptive commodities, no complete records of contraceptive activities, no IEC materials and no family planning checklists. Continuous training of health providers and increased government commitment can help to improve contraceptive services.

Choices and availability of family planning services: evidence from census-based health facility assessment data in Bauchi state, Nigeria

Background: Controlling family planning (FP) has long been the goal of most nations and cultures. FP aims to keep the population under control while also improving living conditions. Many countries, especially the developing ones, which Nigeria is among, face the challenge of dealing with overpopulation due to high fertility rates. FP is considered a veritable way of dealing with high fertility problems. The present study assesses the choices and availability of FP services in Bauchi state health facilities. Methods: This study leveraged Noi Polls census data on Health Facility Assessment for Bauchi state. We conducted a descriptive analysis and analyzed the primary health facility assessment data using counts and percentages. Result: Findings of the study revealed that 80% of the health facilities studied in Bauchi State offer FP services. 91.2% and 77% of the facilities in the urban and rural areas, respectively, offer FP services. This translates to 8.8% and 23% of health facilities in urban and rural areas, respectively, not offering FP services. Based on proportions, assessing the facilities that offer FP by ownership shows that public health facilities are more into FP services (80%) compared to the private-for-profit (80%) health facilities and facilities owned by NGOs and faith-based organizations (83.3%). By facility level of care, 87.5% of secondary healthcare facilities in Bauchi State offer FP services compared to primary healthcare facilities (79.5%). FP services provided in the studied facilities include counseling, contraceptive injectables, oral contraceptive pills, male and female condoms, implants, Intra-Uterine Contraceptive Devices IUCD, sterilization methods, and natural/traditional methods. Conclusion: Considering that over 80% of health facilities considered in this study locates in rural Bauchi state, with over 22% not offering FP clearly shows a gap that the government must address. The distribution of FP services across the state's local government areas is inequitable as some local governments have more health facilities offering the services than others, thus giving residents in those areas a higher chance of benefitting from those services.

Evaluation of the choices and availability of family planning services in Lagos State: A secondary analysis of census-based health facility assessment data from Noi Polls

Maternal mortality rates remain unacceptably high, especially in developing countries like Nigeria. Nigeria is responsible for about 20% of all global maternal deaths, with a Nigerian woman having a 1 in 18-lifetime risk of dying because of pregnancy or childbirth. Evidence-based strategies have been proposed, including family planning (FP), to reduce the incidence of maternal mortality, which is the only strategy that reduces the proportion of high-risk pregnancies and births and reduces exposure to the risk of maternal mortality. Despite these benefits, there is still a high unmet need for family planning services. The present study assesses the choices and availability of FP services in Lagos state health facilities, examines the challenges, barriers, and cultural restraints to modern contraception, and proffers solutions that will help increase FP uptake in the state. The study also presented supply-and-demand interventions that are most effective at increasing voluntary contraceptive uptake in Lagos state.

Influence of family planning and immunization services integration on contraceptive use and family planning information and knowledge among clients: A cross-sectional analysis in urban Nigeria.

Reproductive autonomy necessitates that women have access to high quality family planning information and services. Additionally, closely spaced pregnancies increase maternal and infant morbidity and mortality. Although integrating family planning into child immunization services may increase access to information and services and postpartum contraceptive use, evidence on how integration affects service delivery and health outcomes is scarce. One limitation of previous studies is the use of binary integration measures. To address this limitation, this study applied Provider and Facility Integration Index scores to estimate associations between integration and contraceptive use, receipt of family planning information, and knowledge of family planning services availability. This study leveraged pooled cross-sectional health facility client exit interview data collected from 2,535 women in Nigeria. Provider and Facility Integration Index scores were calculated (0–10, 0 = low, 10 = high) for each facility (N = 94). The Provider Integration Index score measures provider skills and practices that support integrated service delivery; the Facility Integration Index score measures facility norms that support integrated service delivery. Logistic regression models identified associations between Provider and Facility Integration Index scores and (a) contraceptive use among postpartum women, (b) receipt of family planning information during immunization visits, and (c) correct identification of family planning service availability. Overall, 46% of women were using any method of contraception, 51% received family planning information during the immunization appointment, and 83% correctly identified family planning service availability at the facility. Mean Provider and Facility Integration Index scores were 6.46 (SD = 0.21) and 7.27 (SD = 0.18), respectively. Provider and Facility Integration Index scores were not significantly associated with postpartum contraceptive use. Facility Integration Index scores were negatively associated with receipt of family planning information. Provider Integration Index scores were positively associated with correct identification of family planning service availability. Our results challenge the position that integration provides a clear path to improved outcomes. The presence of facility and provider attributes that support integration may not result in the delivery of integrated care.

Pooled prevalence and contextual determinants of contraceptive utilization among reproductive-age women in The Gambia: Evidence from 2013 – 2020 Demographic Health Surveys

Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value &lt;0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.

Regional variation of family planning services in Nigerian health facilities

Background: Availability and accessibility of family planning (FP) services are the major factors affecting the fertility pattern and population growth rate in low-resource settings. This study aimed at assessing the availability of contraceptive methods in Nigeria health facilities offering FP services. Materials and Methods: This study compared survey data on FP services available from each of the six geopolitical zones in Nigeria. The study was a descriptive analysis of variations in the availability of FP services and contraceptive methods across the regions. Result: Out of the 767 facilities surveyed, 375 (48.9%) were located in rural areas and 392 (51.1%) in urban areas. The Northwest had the highest male condom availability of 96.2%. The emergency contraceptive method was being offered by 35.8% of the total 636 facilities reportedly offering the service. The proportion of the facilities offering the oral contraceptive method was higher in the Northeast (100.0%), Northwest (94.9%), and South-South (92.0%) than other regions (P = 0.002). While only 9.3% of facilities in the Northeast and 10.0% in the North-Central were offering sterilization for males, higher proportions, 17.7% of South-East and 32.7% of South-South facilities were offering it. The level of stockout of at least one FP method on the day of this survey was high across all regions, with the Northeast (60.8%) and North-Central (59.9%) having the highest proportion and the Northwest having the least stockouts (46.1%). Conclusion: This study found inconsistent FP services across all the six regions. Also, the proportion of facilities that had a stockout of at least one contraceptive method is unacceptably high and deserves improvement interventions.

Availability and Quality of Family Planning Services in the City of Lubumbashi, Democratic Republic of Congo

Introduction: The long-term availability of contraceptive methods and the provision of quality planning services are bedrock for increasing contra-ceptive prevalence. The objectives of this study are to determine the coverage and availability of family planning (FP) services, as well as to evaluate the quality of these services in the city of Lubumbashi. Methods: From May to June 2017, we carried out a descriptive transversal study in several health facilities (HF) in the city of Lubumbashi. We have comprehensively included all the health facilities we have identified. The data were collected by interviews, documentary analyses and observation, guided by a questionnaire. We calculated the proportions for the different variables and the quality was evaluated using the score we built for this purpose. Results: Our study involved 570 health facilities. The coverage for family planning services was 0.7/10,000 inhabitants. Their availability was 29.6% among the visited structures; 10.1% of HF had no contraceptives in stock, 10.1% had one to two contraceptives and 79.9% had three or more. The quality of FP services was good in the majority (82%) of HF, average in 12% and poor in 6% of the cases. Conclusion: The coverage of FP services and their availability in the city of Lubumbashi were low. The quality of family planning services was good in most health facilities offering FP services. Improving coverage and availability of family planning services in Lubumbashi, as well as the innovation of the most appropriate supply strategies, is essential to increase contraceptive prevalence.

Assessment of Family Planning Service Availability and Readiness in 10 African Countries.

Access to family planning services and appropriate contraceptive methods is crucial for ensuring good health outcomes for women and adolescent girls. The World Health Organization worked with the U.S. Agency for International Development to develop the Service Availability and Readiness Assessment (SARA) survey to measure health facility capacity to provide end users with appropriate, high-quality health care. In this study, we looked at the service availability and readiness of health facilities to provide contraception in 10 African countries: Benin, Burkina Faso, the Democratic Republic of the Congo, Djibouti, Mauritania, Niger, Sierra Leone, Tanzania, Togo, and Uganda. This study compared SARA survey data on family planning services from each of the 10 countries. We conducted a descriptive analysis of variations in facility readiness and the availability of services, contraceptive methods, trained staff, family planning guidelines, and basic health care equipment. Overall, many of the countries surveyed had a relatively high availability of at least 1 contraceptive method. Rural facilities tended to have more availability of contraception than urban facilities, and government facilities tended to have higher availability of family planning than other providers. The countries differed in their particular dominant contraceptive method, and stock-outs of contraceptive methods were observed. Countries had overall low levels of all 6 tracer items (availability of family planning guidelines, staff trained in family planning, blood pressure apparatuses, combined oral contraceptive, injectable contraceptives, and male condoms on the day of the assessment), indicating low health system readiness. There were discrepancies between reported and observed availability of blood pressure apparatuses and family planning guides and having at least 1 staff member trained to use these tools. In all countries, unmarried adolescents appeared to have less access to family planning than the general population. Stock-outs and logistics management problems were common among the countries surveyed. Critical gaps between reported and actual availability of products and services often makes it difficult for end users to access appropriate family planning methods. To address many of the issues, additional health worker training is needed and more effort to target and support adolescents should be undertaken. To achieve universal health coverage targets for family planning, gaps in the availability and readiness of health systems to provide contraceptive products and services must be reduced.

Availability of family planning services and quality of counseling by faith-based organizations: a three country comparative analysis

BackgroundFaith-based organizations (FBOs) have a long history of providing health services in developing countries and are important contributors to healthcare systems. Support for the wellbeing of women, children, and families is evidenced through active participation in the field of family planning (FP). However, there is little quantitative evidence on the availability or quality of FP services by FBOs.MethodsThe descriptive analysis uses facility-level data collected through recent Service Provision Assessments in Malawi (2013–14), Kenya (2010), and Haiti (2012) to examine 11 indicators of FP service and method availability and nine indicators of comprehensive and quality counseling. The indicators include measures of FP service provision, method mix, method stock, the provision of accurate information, and the discussion of reproductive intentions, client’s questions/concerns, prevention of sexually transmitted infections, and return visits, among others. Pearson’s Chi-square test is used to assess the selected indicators by managing authority (FBO, public, and other private sector) to determine statistical equivalence.ResultsResults show that FBOs are less likely to offer FP services than other managing authorities (p < 0.05). For example, 69% of FBOs in Kenya offer FP services compared to 97% of public facilities and 83% of other private facilities. Offering long-acting or permanent methods in faith-based facilities is especially low (43% in Malawi, 29% in Kenya and 39% in Haiti). There were few statistically significant differences between the managing authorities in comprehensive and quality counseling indicators. Interestingly, Haitian FBOs often perform as well or better than public sector health facilities on counseling indicators, such as discussion of a return visit (79% of FBO providers vs. 68% of public sector providers) and discussion of client concerns/questions (52% vs. 49%, respectively).ConclusionsResults from this analysis indicate that there is room for improvement in the availability of FP services by FBOs in these countries. Quality of counseling should be improved by all managing authorities in the three countries, as indicated by low overall coverage for practices such as ensuring confidentiality (22% in Malawi, 47% in Kenya and 12% in Haiti), discussion of sexually transmitted infections (18%, 25%, 17%, respectively), and providing services to youth (53%, 27%, 32%, respectively).

Integrating family planning into HIV care in western Kenya: HIV care providers’ perspectives and experiences one year following integration

ABSTRACTWith high rates of unintended pregnancy in sub-Saharan Africa, integration of family planning (FP) into HIV care is being explored as a strategy to reduce unmet need for contraception. Perspectives and experiences of healthcare providers are critical in order to create sustainable models of integrated care. This qualitative study offers insight into how HIV care providers view and experience the benefits and challenges of providing integrated FP/HIV services in Nyanza Province, Kenya. Sixteen individual interviews were conducted among healthcare workers at six public sector HIV care facilities one year after the implementation of integrated FP and HIV services. Data were transcribed and analyzed qualitatively using grounded theory methods and Atlas.ti. Providers reported a number of benefits of integrated services that they believed increased the uptake and continuation of contraceptive methods. They felt that integrated services enabled them to reach a larger number of female and male patients and in a more efficient way for patients compared to non-integrated services. Availability of FP services in the same place as HIV care also eliminated the need for most referrals, which many providers saw as a barrier for patients seeking FP. Providers reported many challenges to providing integrated services, including the lack of space, time, and sufficient staff, inadequate training, and commodity shortages. Despite these challenges, the vast majority of providers was supportive of FP/HIV integration and found integrated services to be beneficial to HIV-infected patients. Providers' concerns relating to staffing, infrastructure, and training need to be addressed in order to create sustainable, cost-effective FP/HIV integrated service models.

Reproductive Freedom and the Next President

Dr. Eli Adashi and Darrell West discuss how the national debate about “reproductive freedom” has evolved to include the use of human embryos for stem-cell research, the assurance of access to family-planning services and comprehensive sex education, and the Partial-Birth Abortion Ban Act.

How to Help Clients Obtain More Preventive Reproductive Health Care

Many countries have subscribed to the Programme of Action drafted at the International Conference on Population and Development held in Cairo in 1994. However health program managers are confronted with multiple challenges in the actual implementation of the integrated reproductive health programs. Studies in Guatemala evidenced that approximately 29% of women attending health centers were not aware of family planning service availability in their health centers. In addition inadequate screening services were particularly common in the country although screening instruments were existent. In this article possible approaches for promoting reproductive health care are presented. These approaches include the in-reach program wherein integrated services are made more effective efficient and available to clients through behavioral change of both clients and providers. Changes can be implemented with the use of simple instruments at the service delivery point. In Guatemala health services are promoted by the Instituto Peruano de Paternidad Responsable brochure and the Guatemalan Ministry of Health s algorithm promotes client screening.

The Influence of Traditional Religion on Fertility Regulation among the Kassena-Nankana of Northern Ghana

This article presents findings from a study of the influence of traditional religion on reproductive preferences of Kassena-Nankana lineage heads in northern Ghana. Seven reproductive preference questions were administered to nine lineage heads who are primary practitioners of the cult of soothsaying. With the assistance of soothsayers, interviews were repeated in conjunction with the invocation of religious rites in order to determine the views of ancestral spirits on the seven questions. Pairs of lineage head and ancestral interviews are compared to determine the role of traditional religion in shaping male reproductive preferences. Interview pairs reflect a shared preference for sons, large compounds, and a growing lineage. Findings nonetheless show that some ancestral spirits want small families, some even wanting fewer children than corresponding lineage heads. Spiritual consultations are nondogmatic and open to external ideas and influences, suggesting that family planning introduction will not encounter systematic religious opposition among the Kassena-Nankana.

Contextual Effects on the Sexual Behavior of Adolescent Women

The impact of social context on female adolescents sexual behavior subsequent to first intercourse was investigated through use of data on females 15-19 years of age from Cycle III of the 1982 US National Survey of Family Growth. Logistic regression was selected to estimate models for the two dependent variables--experiencing premarital intercourse and coital frequency--for the 566 Black and 1286 White subjects. Community factors such as social disorganization socioeconomic status religiosity female labor force participation population composition and family planning service availability were found to be significant influences on premarital sexual behavior but more so for Black adolescents. The contextual determinants were most operable in terms of ever having premarital intercourse. Census tract variables that increased the likelihood of premarital coitus among Whites included increased percentages of separated or divorced women greater female labor force participation a higher ratio of unmarried males aged 15 years and older to same aged females and lower percentages of Black and foreign-born; at the county level of analysis a high crime rate and low church attendance were significant. Among non-Whites the premarital coitus risk increased with the tract-level variables of increased female employment lower percentage of unmarried adult women and higher numbers of adolescents not in school and with the county-level factors of a high sex ratio and lower levels of urbanization. Among whites increased coital frequency was increased by the percentage of adolescents in the community who are unemployed or school drop-outs low membership in conservative religious groups a high proportion of males to females and a higher percentage of adolescent family planning clinic attendance the sex ratio and the percentage of out-of-school adolescents. These contextual factors tended to influence sexual behavior directly even when individual-level factors were included in the model.

Family Planning in Four Latin American Countries--Knowledge, Use and Unmet Need: Some Findings from the World Fertility Survey

This is a digest of the findings of the World Fertility Survey (WFS) begun in 1971 on several aspects of family planning in 4 Latin American countries: Costa Rica Panama the Dominican Republic and Colombia. The WFS survey included the collection of data on contraceptive knowledge and practice knowledge of family planning service availability ideal family size child spacing and unmet family planning needs. The author points out that there is a great deal of difference in many areas of family planning among the 4 countries; Costa Rica for example has a highly developed and widespread program while Panama has a deficiency in rural service availability. Statistics resulting from the WFS are included in table form showing correlations between contraceptive use and educational level age numbers of children sex of living children type of contraceptive method desire for more children and desire to stop having children. The report deals specifically with perceived rather than concrete data in the area of knowledge availability and desire for more children. The author feels that in Colombia and Costa Rica especially a stepped up program of population education in family planning could result in more dramatic reductions in the fertility rate.

United States, Underdeveloped Land in Family Planning

This paper examines the availability of subsidized family-planning services to poor and near-poor fertile women aged 18 to 44, not desiring pregnancy, in the United States. Examination of data leads to the conclusion that subsidized services are inadequate; that neither state nor local governments are meeting the need; that hospitals and other public health facilities are providing negligible services; that the federal government, despite stated policy favoring the availability of family-planning services to all who want them, is providing minimal funding for the initiation and support of programs.