Provision Of Family Planning Services Research Articles

Factors influencing contraceptive uptake among women of reproductive age in Kenya

Background Modern Contraceptive Methods (MCM) use is among the interventions preventing unplanned pregnancies and unsafe abortions globally. Nevertheless, MCM uptake is still low. We aimed at determining factors influencing contraceptive uptake among women of reproductive age 15 to 49 years, in Kenya. Methods We used secondary data collected by Performance, monitoring for Action (PMA). PMA used cross sectional multi-stage cluster survey design and collected the data between November and December 2019. The study was approved by NACOSTI/202974 and KNERC KNH/ERC/R/192. Results The study obtained a sample size of 9477 women of reproductive age (WRA) from 11 counties in Kenya. Both descriptive and inferential statistical analysis with a P value of 0.05 was done using Stata 16.1. The prevalence of modern contraceptives uptake was 43.2% among all WRA, which was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55). More than half (53.4%) of the married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Women affiliated with the Islam religion were less likely to use modern contraceptive (aPOR 0.6, 95% CI 0.42, 0.89 p=0.010) as compared to the Catholics. Family planning (FP) services were found to be lower (aPOR 0.535(95% CI 0.29,0.98 p=0.043) in National Hospital Insurance Fund (NHIF)-covered facilities than in non-NHIF-covered ones. Adolescent FP service provision and prescription was significant (aPOR 4.0 95% CI; 1.05,15.41, p=0.42). Conclusion Low uptake for MCM is influenced by sociodemographic factors and Health system factors. Efforts to increase MCM uptake should focus on rural residents, unmarried women, Islamic religion women and accreditation of NHIF services in all facilities.

The effects of COVID-19 pandemic on women’s access to maternal health and family planning services in Egypt: an exploratory study in two governorates

BackgroundThe COVID-19 pandemic has been noted to decrease access to maternal health and family planning services globally. However, evidence from the Middle East and North Africa region is very scarce and limited. We qualitatively explored women’s experiences in accessing maternal health and family planning services during the COVID-19 lockdown months in the two Egyptian governorates of Port Said and Souhag.MethodsUsing a case study design, semi-structured phone interviews were conducted with a total of 40 women aged 18–35 years from Port Said and Souhag governorates in Egypt. Interviews explored women’s experiences in accessing maternal health and family planning services during COVID-19 lockdown months, their coping strategies, and impact of challenges and/or coping strategies on participants and their families. The collected data was analyzed manually using qualitative thematic analysis.ResultsMany participants were unable to access maternal health and family planning services during COVID-19 lockdown due to fear of contracting the virus, closure of health facilities, changing service hours, family planning method or drug stock-outs, and/or financial constraints. The above challenges in accessing services along with coping strategies that some women and their families used exposed women to additional health risks, including unintended pregnancies, and posed several social, emotional, and financial burdens to many.ConclusionsThe COVID-19 pandemic and associated lockdown measures undermined women’s access to maternal and family planning services and interfered with their ability to achieve their reproductive goals. The paper concludes with a number of recommendations to ensure access to maternal and family planning services at times of crisis. Those recommendations include: (1) adapting reliable guidelines from humanitarian settings, (2) providing adequate guidance to healthcare providers and the public to tackle fears and misinformation, (3) making self-care products available such as oral contraceptive pills, vaginal rings and self- administered injectables, (4) involving other health professionals in the provision of maternal and family planning services through task-sharing/shifting, (5) expanding the use of telemedicine and/or digital health services especially to those living in remote areas and (6) raising policymakers’ awareness of the centrality of reproductive rights and the importance of protecting them at all times.

United States Government-Supported Family Planning and Reproductive Health Outreach in the Democratic Republic of the Congo: Lessons Learned and Recommendations.

In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants' perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations. Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis. The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects. Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women's feedback about the FP outreach program and our recommendations can inform future policies and interventions.

Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries.

Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.

Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits.

Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics. Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects. The analytic sample included 53,489 patient visits with reproductive-age (15-49years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p=.02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p=.00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services. Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences.

Unraveling the Intersection of Socio-Economic Dynamics and Family Planning Accessibility: Insights from Women of Reproductive Age in Kween District, Eastern Uganda

The provision and utilization of Family Planning (FP) services play a pivotal role in not only safeguarding women's health but also significantly enhancing the overall well-being of their partners, children, and the wider societal fabric. Studies have estimated that optimizing FP services could potentially save 32% of maternal lives and 10% of child lives. In light of these critical implications, this research delves into the multifaceted factors hindering women's access to Family Planning Services within the precincts of the Kween district. Employing a cross-sectional descriptive study design, this investigation focuses on women aged between 18-49 years. Data collection involved survey questionnaires administered to a strategically sampled group of 40 women. The quantitative data underwent meticulous analysis utilizing SPSS version 20, while qualitative data was subjected to content and thematic analysis, presenting findings in a verbatim format. The study revealed that while 47.5% of women were utilizing modern FP methods, encompassing pills, implants, and injectables, there existed a notable unmet contraceptive need of 25%, coupled with a 22.5% contraceptive discontinuation rate. The primary deterrent to accessing modern FP methods stemmed from acceptability issues entrenched in prevailing myths, notably the erroneous beliefs associating Family Planning with infertility and the culturally unfavorable birth of twins. Moreover, the discontinuation of modern FP methods predominantly stemmed from reported side effects such as excessive bleeding, backaches, and headaches. Additionally, the research underscored a correlation between the utilization of modern FP methods, women's educational attainment, and demographic factors like the number of living male children and participation in polygamous marriages. Intriguingly, religious affiliations had a limited impact on FP method utilization, as women demonstrated a tendency to contravene religious doctrines to access FP services despite religious opposition. This study illuminates critical barriers obstructing women's access to and sustained use of modern FP methods in the Kween district, emphasizing the urgency for tailored interventions addressing socio-cultural misconceptions, side-effect management, and demographic sensitivities to foster more inclusive and effective FP service delivery in similar contexts. Keywords: Family Planning, Contraceptives, Injectables, Implants.

Moving policy to practice: role of advocacy in enabling provision of injectable contraceptives by pharmacists in Kenya.

Expanding access to contraceptive services by making them available in pharmacies and drug shops is a family planning high-impact practice. In 2018, Kenya's Ministry of Health amended its family planning guidelines to allow pharmacists and pharmaceutical technologists throughout the country to provide subcutaneous and intramuscular depot medroxyprogesterone acetate. Amending the policy did not necessarily mean that the policy would be implemented. The Advance Family Planning project launched an advocacy campaign to engage key stakeholders to work with the Ministry of Health to implement the policy. Consequently, a family planning training package for pharmacists and pharmaceutical technologists was developed and rolled out. The advocacy process also led to strengthening family planning reporting by the trained pharmacists and pharmaceutical technologists. To further enhance sustainability by ensuring a continuous pool of pharmacy professionals equipped with skills to provide family planning services, Advance Family Planning and its partners advocated with universities and the Pharmacy and Poisons Board to revise the pre-service training curriculum to include family planning as a competence area for pharmacists and pharmaceutical technologists. A key lesson learned is that policy formulation does not necessarily translate to policy implementation. Advocacy is often needed to move policy to practice, especially where resources are required. Policy implementation also requires incremental achievement of milestones and the need for advocacy for each step in the process. Implementation of the policy provision that allows pharmacists and pharmaceutical technologists to provide injectable contraceptives has implications beyond family planning programs. It provides a point of reference for allowing pharmacists to offer other primary health care services, such as immunization, injectable HIV prophylaxis, and other interventions that might not be provided for in policy.

How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda.

Voluntary, rights-based family planning upholds women's right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved participation and maximized the contributions of all participants. It is therefore important to consider participant characteristics and their potential impact on the process, especially when engaging diverse participant groups, and implement measures to mitigate their effects.

Mobile programs in family planning.

Mobile health outreach programs are an alternative way to provide family planning services for rural populations or populations affected by conflict, outbreaks, or humanitarian crises. Here, we review the current literature about mobile health outreach programs in family planning. Mobile health outreach programs are effective in delivering family planning services by increasing access to family planning services including expanding method choice, contributing to resilient healthcare models, and advancing reproductive justice.Mobile health outreach programs may be a reasonable, cost saving, person-centered alternative to delivering healthcare particularly when traditional systems are strained. Mobile health outreach programs in family planning exist in the United States and globally. Current literature suggests that mobile and outreach programs are effective in increasing knowledge and access to family planning in part by expanding method choice. A mobile health outreach approach is a resilient model that is person-centered and lends itself well to empower patients to practice self-care. The findings and lessons learned may be helpful in guiding future mobile health outreach programs in family planning and other services conducive to an out of clinic model, particularly as a response to overburdened health systems.

Analisis Kejadian Putus Pakai Kontrasepsi di Provinsi Sumatera Utara

The Family Planning Program (KB) is one of the strategies carried out by the government to suppress the increase in the rate of population growth. The Family Planning Program (KB) will not run well if there is a family planning dropout. Women of childbearing age (WUS) who experience discontinuation of family planning will increase the risk of conception. This study uses secondary data from the 2017 IDHS for 945 women of childbearing age who have used modern family planning. This study uses secondary data from the 2017 IDHS for Women of Childbearing Age (WUS). This study uses cross-tabulation to determine the distribution of husbands' approval regarding family planning devices, wanting more children, side effects of family planning, the role of family planning service providers, and the incidence of dropping out of family planning use in North Sumatra Province. The results of this study indicate that there are 238 women of childbearing age (25.8%) who drop out of family planning use and 707 women of childbearing age (74.8%). The incidence of dropping out of family planning in North Sumatra Province mostly occurs to women of childbearing age who experience side effects of family planning as many as 238 women of childbearing age and women of childbearing age who still want more children many as 67 women of childbearing age. The BKKBN of North Sumatra Province must provide training to field worker family planning on side effects of family planning to improve the skills of PLKB in providing counselling about side effects of family planning in women of childbearing age. Fieldwork family planning North Sumatra Province must provide health counselling to women of childbearing age before deciding to use contraceptive methods to minimize the side effects of family planning in women of childbearing age.

Impact of the COVID-19 pandemic on women’s contraceptive use: a mixed-methods study in South Africa and Zambia

Background: The COVID-19 pandemic affected global access to health services, including contraception We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users’ desire and ability to obtain removal. Methods: Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results: Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported attempting to access FP since the start of the pandemic, the vast majority using short-acting methods. Among those who sought services, 95% obtained their preferred method. The proportion of women not using a method before and after pandemic start did not change in Zambia (31%); in South Africa, the proportion increased from 8% to 10%. Less than 7% of implant or IUD users in either country reported wanting removal. Among those who sought removal (n=22), 91% (n=10) in Zambia and 55% (n=6) in South Africa successfully obtained removal. In qualitative interviews, women with challenges accessing FP services mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions: We did not find a substantial impact of COVID-19 on contraceptive access among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people’s ability to access their preferred contraceptive methods.

Challenges in last mile distribution of family planning commodities: Effects on product availability and accessibility in Nigeria.

Family planning (FP) reduces maternal and child mortality risk. Despite policies and plans to improve FP in Nigeria, access remains poor leading to high unmet need. Contraceptive use is still as low as 4.9% in some regions. Thus, this study assessed challenges in FP commodities distribution and its effect on accessibility. Descriptive survey was used to explore last mile distribution of FP commodities in 287 facilities across various levels of FP service provision. Also, 2528 end users of FP services were assessed to ascertain their attitudes towards FP services. Data were analysed using IBM Statistical Package for the Social Sciences version 25. Only 16% of the facilities had all the basic infrastructure requirements assessed with majority of the facilities having inadequate human resource capacity on logistics and supply chain management of health commodities. The study also identified positive attitudes towards FP (80%) and low incidence of stigmatising attitudes (5.4%). The study identified challenges in distribution of FP commodities including frequent stock out of commodities and socio-cultural barriers. Increased positive attitude and limited stigmatising attitudes provides policy directions that are relevant for decision makers to align FP policies and strategies to improve last mile distribution of FP commodities.

Are trained family planning service providers competent? analyzing the results of diagnostic workshops to improve capacity building in family planning

Are trained family planning service providers competent? analyzing the results of diagnostic workshops to improve capacity building in family planning

EDUCATIONAL TRAINING OF LADY HEALTH WORKERS AND PREVENTION OF ABORTION RELATED MORBIDITY AND MORTALITY

One of the major challenges faced by developing world for achieving universal health care includes shortage of Manpower indicated by the fact that an estimated one billion people will never see a health worker during the course of their lives. As a consequence to this shortage millions of people die or are disabled each year1. One solution to this dilemma was increasing health workforce by induction of community health workers (CHWs), members of the community who are trained to provide basic health services. They offer the first and at times only admittance to health services for people in the developing world2. But, research has shown that, CHWs are not effectively trained, remunerated, or retained. In Pakistan Lady Health Worker Program started with the overall goal to contribute to poverty reduction by improving the health of the people. So Lady Health Workers (LHWs) were recruited and trained to provide family planning services and primary health care (PHC) in their own communities3. The health services, based on PHC, include among other things: education concerning prevailing health problems and the methods of preventing and controlling them, and provision of essential drugs and supplies. One of the major current problems is Abortion. Worldwide 61% (Six out of 10) of all unintended pregnancies, and 29 % (3 out of 10) of all pregnancies, end in induced abortion. And out of all abortions around 45% are unsafe, of which 97% occurring in developing countries4. An estimated Over two million abortions are performed annually in Pakistan5. Involved health risks depend on whether the procedure is performed safely or unsafely. Unsafe abortion is common in rural areas, where plant species are used to terminate an unwanted pregnancy6 and restricted abortion law countries ,where most attempt to self-abort or go to untrained person7. fIn Pakistan, mostly abortions are due to unwanted pregnancy, poverty, lack of awareness about Reproductive Health and Family planning methods on part of both husband and wife. Abortion related care includes emergency treatment of abortion, post-abortion family planning services including counseling and making links between the post-abortion emergency services and the reproductive healthcare system. A Lady Health worker informs and counsels any pregnant adolescent about the possible consequences (medical and psychological) of unsafe abortion. In case of any of any of such complication’s immediate referral to a higher health facility (often a hospital) is needed where she can get sufficient care. Delay in seeking care specially demands improved reproductive health information about abortion care. Improving current PAC services at lower level facilities will also minimize delays resulting from long referral processes8. Improving knowledge through trainings of the health workers about prevention of abortion and risk factors will bridge the gap between the current and ideally required level of knowledge for delivering preventive abortion related health care services. Theses trained health workers can utilize this knowledge for increasing awareness among reproductive age group females especially of rural community. And eventually abortion related morbidity and mortality can be significantly reduced which will contribute for attainment of the Sustainable MDG related to decreasing maternal morbidity and mortality.

Knowledge and practice of modern contraceptive methods among married agro-pastoral women in Jigjiga District of Somali Regional State, Ethiopia.

Modern contraception has played a significant role in reducing maternal and child mortality. The study was aimed at assessing the knowledge and practice of modern contraception among agro-pastoral women in the Jigjiga district of the Somali regional state. The study employed a cross-sectional quantitative research design. A total of 383 agro-pastoral women between the ages of 15 and 49 years who were married were randomly taken from 11 kebeles (the smallest administrative unit). The data were collected through a structured and pre-tested questionnaire via the face-to-face interview technique by trained enumerators. Frequency and percentage were used to analyze the collected data. The study found that 21.1% of agro-pastoral women respondents were aware of modern contraception methods. Despite this fact, the prevalence of modern contraception at the time of data collection was 4.7%. Injectables and pills were the modern contraception used by most of the respondent women. The result of the study shows the low level of modern contraception utilization which calls for strong measures to let the agro-pastoral women use various methods. Therefore, it is important to have an awareness creation campaign to motivate women to use modern contraception and improve the family planning service provision in the region.

Factors associated with utilization of modern postpartum family planing methods during the extended postpartum period among mothers who gave birth in the last 12 months at Injibara town, Northwest, Ethiopia: a cross-sectional study

BackgroundThe extended postpartum period is the first twelve months following childbirth and is an important entry point for family planning service providers to reduce unintended and too closely spaced pregnancies. A modern postpartum family planning service is one of the recommended public health interventions for reducing maternal and child morbidity and mortalities in sitting where maternal mortality is high, like in Ethiopia.ObjectiveThis study was aimed to assess factors associated with the utilization of modern family planning methods during the extended postpartum period among mothers who gave birth in the last 12 months at Injibara town, Northwest, Ethiopia.MethodsA community-based cross-sectional study design was employed from March 1–15/2019 at Injibara town among 402 mothers. The data was collected by a simple random sampling technique and analyzed using the SPSS 23.0 version. Logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 in multivariable analysis considered statistically significant. Frequency tables and descriptive summaries were used to describe the study variables.ResultsThe total sample size of this study was 402 and among them, 400 postpartum mothers participated in the study with a response rate of 99.5%. The utilization of modern family planning methods during the extended postpartum period among postpartum mothers was 58.5% [95% CI: 53.5- 63%]. Of these, 38.9% and 32.9% of the mothers were using injectables and implants respectively. Secondary and above educational level, having ≥ 3 antenatal care visits, resumption of menstruation, discussing with the partner on utilization of family planning method, being counseled on family planning method utilization during antenatal care visits and immediately after delivery, linkage of the mothers to a family planning unit during child immunization, and having good knowledge of family planning methods were associated with utilization of modern family planning methods during the extended postpartum period.ConclusionThe utilization of modern family planning methods during the extended postpartum period among postpartum women was low compared to the world health organization recommendation. Socio-demographic, health care service uptakes, and reproductive characteristics were associated with the utilization of modern family planning methods during the extended postpartum period. We suggest emphasizing the education and counseling of women on the utilization of family planning during maternal and child health care service utilization. Mothers should be encouraged to start using modern family planning methods before the resumption of menses.

Restrictions on contraceptive services for unmarried youth: a qualitative study of providers’ beliefs and attitudes in India

Sexual and reproductive health (SRH) of unmarried youth is an important issue, particularly in Indian society, where premarital sex is socially restricted. It is an uncomfortable subject for most people, including healthcare providers, who are responsible for catering to the reproductive health needs of youth. This is because of the prevailing social norms, where sex outside marriage is discouraged and stigmatised. These social norms give importance to virginity, and children outside marriage are not welcome. The present qualitative study was conducted in public health facilities (primary and secondary) to explore the attitudes of healthcare providers in providing contraceptive services to unmarried youth. In-depth interviews were conducted with family planning (FP) service providers (frontline healthcare workers [ASHAs] nurses and FP counsellors) between October 2017 and September 2018. Almost a quarter of the providers were either hesitant or against providing contraceptives to unmarried youth. Providers stated that they preferred emergency contraceptive pills for unmarried girls if they had already engaged in unprotected sex. Providers expressed strong personal views against premarital sex because they believed it was against existing social norms. Some providers were concerned about the possible negative reactions of the community if they recommended any contraceptive to unmarried youth. A few providers even considered it illegal to provide contraceptives to unmarried youth, though there is no such law in the country. Findings further indicated that though the country had launched programmes for improving adolescents and youth SRH, service providers were still conflicted between medical eligibility and social beliefs.

Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya

BackgroundWomen seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention—the Community Score Card (CSC)—in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision.MethodsWe implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics.ResultsThe involvement of community health volunteers and supportive community members – as well as the willingness of some providers to consider changes to their own behaviors—were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services.ConclusionSuccessful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC – or other social accountability efforts – can result in improved contraceptive access.

Primary Health Care Management Effectiveness as a Driver of Family Planning Service Readiness: A Cross-Sectional Analysis in Central Mozambique.

The effectiveness of facility-level management is an important determinant of primary health care (PHC) reach and quality; however, the nature of the relationship between facility-level management and health system effectiveness lacks sufficient empirical grounding. We describe the association between management effectiveness and facility readiness to provide family planning services in central Mozambique. We linked data from the Ministry of Health's 2018 Service Availability and Readiness Assessment and a second 2018 health facility survey that included the World Bank's Service Delivery Indicators management module. Our analysis focused on 68 public sector PHC facilities in Manica, Sofala, Tete, and Zambézia provinces in which the 2 surveys overlapped. We used logistic quantile regression to model associations between management strength and family planning service readiness. Of the 68 facility managers, 47 (69.1%) were first-time managers and (18) 26.5% had received formal management training. Managers indicated that 63.6% of their time was spent on management responsibilities, 63.2% of their employees had received a performance review in the year preceding the survey, and 12.5% of employee incentives were linked to performance evaluations. Adjusting for facility type and distance to the provincial capital, facility management effectiveness, and urban location were significantly associated with higher levels of readiness for family planning service delivery. We found that a higher degree of management effectiveness is independently associated with an increased likelihood of improved family planning service readiness. Furthermore, we describe barriers to effective PHC service management, including managers lacking formal training and spending a significant amount of time on nonmanagerial duties. Strengthening management capacity and reinforcing management practices at the PHC level are needed to improve health system readiness and outputs, which is essential for achieving global Sustainable Development Goals and universal health coverage targets.

Nigerian stakeholders’ perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services

BackgroundCommunity Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria’s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project.MethodsTwo rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted.ResultsFifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs.ConclusionScale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services.