<p>Are Women In Lomé Getting Their Desired Methods Of Contraception? Understanding Provider Bias From Restrictions To Choice</p>

Abstract

BackgroundDespite improvements in contraception availability, women face persistent barriers that compromise reproductive autonomy and informed choice. Provider bias is one way in which access to contraception can be restricted within clinical encounters and has been established as common in sub-Saharan Africa. This analysis assessed the prevalence of provider restrictions and the potential impact on women’s method uptake in Lomé, Togo.MethodsThis sub-analysis used survey data from provider and client interviews collected to assess the impacts of the Agir pour la Planification Familiale (AgirPF) program in Togo. The relationships between provider restrictiveness and women’s receipt of their desired method of contraception were modelled using mixed effects logistic regressions looking at all women and among subgroups hypothesized to be at potentially higher risk of bias.ResultsAround 84% of providers reported a restriction in contraceptive provision for the five contraceptive methods explored (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Among all women, there were no significant associations between provider restrictiveness and women’s receipt of desired method, including among those who desired long-acting methods. In adjusted modeling, marital status was a covariate significantly associated with desired method, with married women more likely to receive their desired method than unmarried women (aOR 2.73, 95% CI 1.45–5.13).ConclusionProvider reports of high levels of restrictions in this population are concerning and should be further explored, especially its effects on unmarried women. However, restrictions reported by providers in this study did not appear to statistically significantly influence contraceptive method received.

WITHDRAWN: Do provider behaviors influence client satisfaction of family planning services in Togo? Evidence from a cross-sectional facility survey

“…There is limited evidence from Togo on the factors in uencing contraceptive uptake and use which can be used to inform family planning programs. Among the few family planning related studies conducted in Togo, the majority examined male engagement and the need to address misconceptions surrounding modern methods and the risks of advanced maternal age and high parity pregnancy through appropriate channels such as facility, community and home based counseling in order to increase contraceptive use (4,(21)(22)(23). Evidence from facility-based surveys in Togo found high levels of provider restrictions for family planning related to partner consent, age, and marital status but did not nd an effect on whether clients were able to obtain their preferred methods as a result (21).…”

“…Among the few family planning related studies conducted in Togo, the majority examined male engagement and the need to address misconceptions surrounding modern methods and the risks of advanced maternal age and high parity pregnancy through appropriate channels such as facility, community and home based counseling in order to increase contraceptive use (4,(21)(22)(23). Evidence from facility-based surveys in Togo found high levels of provider restrictions for family planning related to partner consent, age, and marital status but did not nd an effect on whether clients were able to obtain their preferred methods as a result (21). Strategies aimed at improving the quality of post abortion care by increasing providers knowledge, attitudes and skills and reducing unnecessary restrictive biases were found effective in increasing access to contraception (24,25).…”

<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

“…In another analysis utilizing this same dataset, the authors found that though provider restrictions were widespread, they did not affect women's ability to receive the method they wanted among women who had a desired method prior to their FP consultation. 38 Though there could be different explanations for this finding, the one that seems most plausible is that a woman's demand for a specific method overrides the provider's restrictions. Potentially, women who arrive at the clinic with a desired method in mind are able to negotiate receipt of this method, even in cases where the provider reported a restriction.…”

“…Meanwhile, most provider-imposed restrictions are related to age and marital status. [38][39][40] We hypothesized that provider training would be associated with LARC uptake, since other studies in SSA have found providers to be a barrier based on biases based on sociodemographics, misconceptions about safety or lack of training in provision. 41 However, we did not find a significant association between provider training and LARC uptake, which could be due to several reasons.…”

“…This suggests that the training was potentially more successful in improving skills, but not attitudes. 38 Knowledge transfer during training is important, but the implementation of knowledge acquired as demonstrated by the provider's practice after the training is even more important. This finding provides additional evidence on the critical role of supervisory visits.…”