Accessing DMPA-SC through the public and private sectors in Nigeria: users’ characteristics and their experiences

Abstract

Background: Beginning in 2015, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was added to the contraceptive method mix in Nigeria, primarily through social marketing in the private sector and community-based distribution in the public sector. We compare user experiences in acquiring DMPA-SC across sectors during this national scale-up. Methods: From October 2017 to February 2018, 459 women (Npublic=235; Nprivate=224) completed a phone survey from a convenience sample of 1,444 women (Npublic=912; Nprivate=532) who obtained DMPA-SC from participating providers and agreed to be contacted. We examined the sociodemographic predictors of attending a public vs. private provider and analyzed differences in care-seeking across sectors (becoming aware of DMPA-SC, choosing a provider, choosing DMPA-SC, quality of care). Results: Respondents obtaining DMPA-SC from public providers were younger and less educated than those attending private providers. Both program respondents were comprised of similar percentages of new users of modern contraception (58.7-60.3%), although most respondents became aware of DMPA-SC through a friend/family member (43.1%) or a provider (41.5%). Relatively more public sector respondents also heard about DMPA-SC through community outreaches whereas relatively more private sector respondents became aware through media. Convenience was the most common reason for choosing a provider—43.8% among all respondents (higher among public sector respondents). Private sector respondents were also more likely to choose a past or usual provider. Having overall higher quality interactions were more likely among clients who attended private providers than public providers, but responses to individual quality item measures show specific areas of poor quality for providers in each sector. Conclusions: Training emphasizing technical thoroughness, sensitivity toward younger women, and client choice may help improve women’s experiences with obtaining DMPA-SC, ultimately contributing to accelerating demand for and uptake of DMPA-SC specifically and contraception in general.

Self-injected contraceptives: does the investment reflect women’s preferences?

“…11 22 Nigeria tackled both private and public sector delivery, using innovative supply-side solutions such as targeting high-volume contraceptive service facilities and in-facility trainings for providers. 18 23 The country's national guidelines for selfinjection involve several visits to the provider to achieve proficiency before a user is given doses to self-administer without health provider supervision. 24 In comparison, the roll-out of DMPA-SC in Kenya has been delayed and only recently expanded to public health facilities countrywide; self-injection has not yet been approved within this context.…”

Missed opportunity for self-injectable contraception awareness and adoption: Insights from client exit interviews in Uganda and Nigeria

“…It is against this background that the Children Investment Fund Foundation funded the Delivering Innovation in Self-Care project (2020–2024) in Uganda and Nigeria to support women to initiate, adopt, sustain use of, and advocate for SI as a cornerstone of sexual and reproductive healthcare among women in urban settings. Nigeria approved DMPA-SC for SI in 2016 while Uganda approved it in 2017 to leverage the popularity of injectables which remains to be the most popular method among married women [14] . In this study that was conducted as part of the formative phase of the Delivering Innovation in Self-Care project, data were collected from public sector health facilities among family planning clients in Uganda and Nigeria to develop a simple, visual information cascade that can be used to identify potential missed opportunities for the provision of SI information and counseling among women seeking FP services.…”

DMPA-SC stock: Cross-site trends by facility type

“…Routine information from the Health Management Information Systems (HMIS) or Logistics Management Information Systems (LMIS) are also lacking, with insufficient client characteristics, incomplete reporting from private facilities, and data aggregations that restrict client-level analysis [ 6 , 7 ]. The limited set of studies on supply-side factors mostly explore service provider-related characteristics and behaviors, with minimal or no data on method availability [8] , [9] , [10] , [11] . The Performance Monitoring for Action (PMA) project collects national data on DMPA-SC from service delivery points and a representative sample of women, but the few publications to date have largely focused on user characteristics [ 3 , 5 , 12 ].…”