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 ).…”

“…For example, a survey of 20 public and private family planning service providers throughout all four districts of Uganda found that one-quarter of providers reported women needed to be a minimum age or have a minimum number of children to be referred for long-acting contraception methods (Wright et al 2017). 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 2006;Nalwadda et al 2011;Tumlinson, Okigbo, and Speizer 2014).…”

Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis

“…From the studies published between 2000 and 2019, a total of 11 272 participants were included in this review with the sample size ranging from 31 to 2 377. and perceptions of HCW's by ten studies (34,(37)(38)(39)(40)46,51,53,54,56,57). A detailed summary of the study characteristics is outlined in Table 2 and Table 3 presents the characteristics of the HCWs included in each study.…”

“…Using the quality assessment tool designed specifically for KAP studies, a total score out of was assigned to each study (27). Eight studies (32)(33)(34)42,45,47,49,53) scored at least 15 or higher indicating good quality and eleven (35)(36)(37)41,43,44,46,48,(50)(51)(52) scored 14 or less indicating low quality. The three studies (38)(39)(40) that utilised a mixed-method study design were indicative of good quality.…”

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).…”