Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso

Browne, Lalique; Cooper, Sarah; Tiendrebeogo, Cheick; Bicaba, Frank; Bila, Alice; Bicaba, Abel; Druetz, Thomas

doi:10.1186/s12978-022-01375-0

Cited by 6 publications

(6 citation statements)

References 43 publications

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“…Radio is an important media source for disseminating family planning information to adolescent girls in rural areas and to groups of young people who are not literate enough to read and understand. This has been made possible due to local radio stations that broadcast in indigenous languages [ 46 , 47 ]. Newspapers and magazines are also important communication channels for educating the young population about family planning [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries

Michael,

Ojo,

Ijabadeniyi

et al. 2024

PLoS ONE

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Introduction Various countries in sub-Saharan Africa have taken divergent steps toward achieving the Sustainable Development Goal’s target of universal access to sexual and reproductive health-care services by 2030, particularly among sexually active adolescent girls who are at risk of unplanned pregnancies and sexually transmitted infections. However, because contraceptive use among sexually active adolescents remains unexplored in sub-Saharan Africa, the researchers intended to examine the prevalence and factors associated with contraceptive use among adolescent girls who had been sexually active in the previous four weeks. Materials and methods Cross-sectional data from the most recent demographic and health surveys of 25 sub-Saharan African countries on 16,442 sexually active adolescent girls were analyzed. In the analyses, descriptive statistics and multivariate binary logistic regression were used. Analyses were statistically significant at p<0.05. Results The overall prevalence of contraceptive use was 25.4%. Chad had the lowest prevalence (4%), while Namibia had the highest (60.5%). Over 90% of the countries studied had less than 50% contraceptive use among sexually active adolescent girls. Adolescent girls withhigher education were eight times more likely than those with no formal education to use contraception (aOR = 7.97, 95% Cl = 6.26-9.45). When compared to single adolescent girls, married adolescent girls were 66% less likely to use contraceptives (aOR = 0.34, 95% Cl = 0.31-0.36). Adolescent girls with two or more children were seven times more likely than those without a child to use contraceptives (aOR = 6.91, 95% Cl = 5.58-8.56). Conclusion It is established that there exists a low prevalence of contraceptive use among adolescent girls in sub-Saharan Africa. As countries in the sub-region strive for universal access to reproductive health services, it is critical for the governments and civil societies in countries with low contraceptive use to strengthen mass education on the use of contraception among sexually active adolescents, with special emphasis on the less educated, married, and adolescent girls from poor households.

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Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries

Michael,

Ojo,

Ijabadeniyi

et al. 2024

PLoS ONE

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“…At the time this survey took place, contraception was not available free of charge in Burkina Faso. 42 However, on 1 June 2019, the government of Burkina Faso committed to offering no-cost family planning services. Future research into how this important reduction in financial barriers to contraceptive access affects the use of non-preferred methods in Burkina Faso is therefore an important next step for this research.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study

Bullington

Sawadogo

Tumlinson

et al. 2023

Sexual and Reproductive Health Matters

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Family planning researchers have traditionally focused efforts on understanding contraceptive non-use and promoting contraceptive uptake. Recently, however, more scholars have been exploring method dissatisfaction, questioning the assumption that contraceptive users necessarily have their needs met. Here, we introduce the concept of “non-preferred method use”, which we define as the use of one contraceptive method while having the desire to use a different method. Non-preferred method use reflects barriers to contraceptive autonomy and may contribute to method discontinuation. We use survey data collected from 2017 to 2018 to better understand non-preferred contraceptive method use among 1210 reproductive-aged family planning users in Burkina Faso. We operationalise non-preferred method use as both (1) use of a method that was not the user’s original preference and (2) use of a method while reporting preference for another method. Using these two approaches, we describe the prevalence of non-preferred method use, reasons for using non-preferred methods, and patterns in non-preferred method use by current and preferred methods. We find that 7% of respondents reported using a method they did not desire at the time of adoption, 33% would use a different method if they could and 37% report at least one form of non-preferred method use. Many women cite facility-level barriers, such as providers refusing to give them their preferred method, as reasons for non-preferred method use. The high prevalence of non-preferred method use reflects the obstacles that women face when attempting to fulfil their contraceptive desires. Further research on reasons for use of non-preferred methods is necessary to promote contraceptive autonomy.

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“…However, with a demonstrated 86% increase in contraceptive use and 13 percentage point reduction in the prevalence of UNC, the abolition of user fees is arguably one of the most effective financial strategies for increasing access to family planning services in LMICs. It is expected that the population impact of the new policy will increase as a greater proportion of the population becomes aware of its existence: For reasons explored elsewhere, only 55% of the participants knew about the new policy six months after its introduction [ 26 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…The new policy covers 100% of the cost of FP consultations, counselling, tests, examinations, and contraceptives themselves (injectables, implants, copper intrauterine devices, emergency contraceptive pills, condoms, surgical methods, and a range of natural methods). More information about the policy’s implementation is available elsewhere [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…A year later, the pilot was scaled up nationally. Despite supply shortages, insufficient communication, and other factors that limited the policy’s coverage [ 26 ], its implementation was deemed successful, but further evidence is needed to determine whether the new policy has affected contraceptive use among women. We designed a pre-post study with a non-randomized control group to assess the effects of the user fee removal policy on contraceptive use in women of reproductive age (WRA) in Burkina Faso.…”

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confidence: 99%

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Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso

et al. 2022

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Background Unmet needs for contraception constitute a major public health problem in sub-Saharan Africa. Several mechanisms have been tested to reduce the financial barrier and facilitate access to family planning services, with inconclusive results. Based on the positive impacts following the introduction of free health care for pregnant women, Burkina Faso decided to extend its national policy and abolished direct payment for family planning services. This study aims to evaluate the impact of this policy on contraceptive use and unmet needs for contraception among women of reproductive age (WRA) in Burkina Faso. Methods This study uses two different study designs to examine the impact of a user fee removal policy on contraceptive use across a panel of 1400 households randomly selected across eight health districts. Data were collected using a standardized socio-demographic questionnaire at three different time points during the pilot and scale-up phases of the fee abolition program. The questionnaire was administered six months after the launch of the pilot fee abolition program in four health districts. For the remaining four health districts, the survey was conducted one year prior to and six months after the implementation of the program in those areas. All WRA in the households were eligible to participate. A cross-sectional study design was used to determine the association between knowledge of the fee abolition policy among WRA and actual use of contraceptives by WRA six months after the policy’s implementation and across all eight districts. Additionally, a pre-post study with a non-randomized, reflexive control group was designed using repeated surveys in four health districts. Hierarchical logistic mixed effects models were adjusted for a set of time-variant individual variables; the impact was assessed by a difference-in-differences approach that compared pre-post changes in contraception use in women who knew about the new policy and those who did not. Results Of the 1471 WRA surveyed six months after the removal of user fees for family planning services, 56% were aware of the policy’s existence. Knowledge of the fee abolition policy was associated with a 46% increase probability of contraceptive use among WRA six months after the policy’s implementation. Among the subset of the participants who were surveyed twice (n = 507), 65% knew about the fee removal policy six months after its introduction and constitute the intervention group. Pre-post changes in contraceptive use differed significantly between the intervention (n = 327) and control groups (n = 180). Removing user fees for family planning led to an 86% (95% confidence interval (CI) = 0.49, 1.31) increase in the likelihood of using contraception. In the study area, the policy reduced the prevalence of unmet needs for contraception by 13 percentage points. Conclusions Removing user fees for family planning services is a promising strategy to...

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Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso

Cited by 6 publications

References 43 publications

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries

Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries

Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study

Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso

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