Provider barriers to family planning access in urban Kenya

Abstract

Objective A better understanding of the prevalence of service provider-imposed barriers to family planning can inform programs intended to increase contraceptive use. This study, based on data from urban Kenya, describes the frequency of provider self-reported restrictions related to clients’ age, parity, marital status, and third party consent, and considers the impact of facility type and training on restrictive practices. Study Design Trained data collectors interviewed 676 service providers at 273 health care facilities in five Kenyan cities. Service providers were asked questions about their background and training and were also asked about age, marital, parity, or consent requirements for providing family planning services. Results More than half of providers (58%) reported imposing minimum age restrictions on one or more methods. These restrictions were commonly imposed on clients seeking injectables, a popular method in urban Kenya, with large numbers refusing to offer injectables to women younger than twenty years. Forty-one percent of providers reported they would not offer one or more methods to nulliparous women and more than one in four providers reported they would not offer the injectable to women without at least one child. Providers at private facilities were significantly more likely to impose barriers, across all method types, and those without in-service training on family planning provision had a significantly higher prevalence of imposing parity, marital, and consent barriers across most methods. Conclusion Programs need to address provider-imposed barriers that reduce access to contraceptive methods particularly among young, lower parity, and single women. Promising strategies include targeting private facility providers and increasing the prevalence of in-service training.

Trends in Modern Contraceptive Use among Young Adult Women in sub‐Saharan Africa 1990 to 2014

“…Comparable findings about discrimination in type of provision based on parity have been noted in other studies in Kenya, South Africa, and Uganda (Wood and Jewkes ; Nalwadda et al. ; Tumlinson, Okigbo, and Speizer ).…”

Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April–July 2016

“…Tanzania had an estimated 8200 maternal deaths in 2015, the fourth highest number of maternal deaths in sub-Saharan Africa and the sixth highest number in the world [ 1 ]. Family planning (FP) can reduce the risk of maternal and neonatal mortality by reducing the number of short birth intervals, as well as unplanned and high-risk pregnancies [ 2 – 7 ]. In 2016, the total fertility rate (TFR) in Tanzania’s Western Zone, which includes Kigoma Region, was 6.7 births per woman – the highest TFR in all of Tanzania [ 8 ].…”

HIV Prevention at Drug Shops: Awareness and Attitudes Among Shop Dispensers and Young Women About Oral Pre-Exposure Prophylaxis and The Dapivirine Ring in Shinyanga, Tanzania

“…In many countries where pre-exposure prophylaxis (PrEP) is available, AGYW are prioritized for PrEP outreach (2), yet early evidence demonstrates suboptimal PrEP uptake and coverage among AGYW (3,4). The gap in implementation may be partially explained by the unique barriers AGYW face when accessing sexual and reproductive health (SRH) services in healthcare facilities, such as stigma and provider bias (5)(6)(7)(8)(9). Shortages of workers and supplies also impede delivery of services at many facilities (10), forcing AGYW to travel longer distances at greater costs (11,12).…”