The Experience and Impact of Contraceptive Stockouts Among Women, Providers and Policymakers in Two Districts of Uganda

Grindlay, Kate; Turyakira, Eleanor; Kyamwanga, Imelda T.; Nickerson, Adrianne; Blanchard, Kelly

doi:10.1363/42e2016

Cited by 17 publications

(21 citation statements)

References 8 publications

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“…Some women blamed health facilities or providers for the stockouts and increased cost of their methods, similar to findings in Uganda where women misinterpreted stockouts as health workers' refusal to administer services. [43] When the preferred method was not available, providers encouraged women to change contraceptive methods, a move that impacts women's autonomy and further contributes to mistrust of health workers/facilities. [44] Stockouts and women's inability to obtain their method of choice are among the issues of service quality that are associated with contraceptive discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

Ravaoarisoa¹,

Razafimahatratra²,

Rakotondratsara³

et al. 2020

Sexual and Reproductive Health Matters

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Madagascar's health system is highly dependent on donor funding, especially from the United States (US), and relies on a few nongovernmental organisations (NGOs) to provide contraceptive services in remote areas of the country. The Trump administration reinstated and expanded the Global Gag Rule (GGR) in 2017; this policy requires non-US NGOs receiving US global health funding to certify that neither they nor their sub-grantees will provide, counsel or refer for abortion as a method of family planning. Evidence of the impact of the GGR in a country with restrictive abortion laws, like Madagascar-which has no explicit exception to save the woman's life, is limited. Researchers conducted semistructured interviews with 259 representatives of the Ministry of Health and NGOs, public and private health providers, community health workers and contraceptive clients in Antananarivo and eight districts between May 2019 and March 2020. Interviews highlighted the impact of the GGR on NGOs that did not certify the policy and lost their US funding. This reduction in funding led to fewer contraceptive service delivery points, including mobile outreach services, a critical component of care in rural areas. Public and private health providers reported increased contraceptive stockouts and fees charged to clients. Although the GGR is ostensibly about abortion, it has reduced access to contraception for the Malagasy population. This is one of few studies to directly document the impact on women who themselves described their increased difficulties obtaining contraception ultimately resulting in discontinuation of contraceptive use, unintended pregnancies and unsafe abortions.

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Section: Discussionmentioning

confidence: 99%

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

Ravaoarisoa¹,

Razafimahatratra²,

Rakotondratsara³

et al. 2020

Sexual and Reproductive Health Matters

View full text Add to dashboard Cite

show abstract

“…• By 8 weeks postpartum, more women initiated family planning in the voucher group (144 [91%]) than in the control group (83 [52%]). The family planning uptake rates were also high for both groups, with higher rates among the intervention group at 12,14,16, and 20 weeks postpartum.…”

Section: Author Summarymentioning

confidence: 93%

“…Although family planning is freely available in public health facilities, stockouts, especially of the long-acting contraceptive methods (implants and IUDs), attributed mainly to supply chain challenges are common [12]. The study promoted minimal stockouts of all methods at MRRH during the study period through regular involvement in forecasting and ordering.…”

Section: Study Proceduresmentioning

confidence: 99%

“…The study promoted minimal stockouts of all methods at MRRH during the study period through regular involvement in forecasting and ordering. Private facilities rarely experience contraceptive method stockouts [12], and thus the family planning voucher also offered an opportunity for free administration (for example, injection, IUD placement, implant) of a contraceptive method purchased outside of the public healthcare facility. For this study, women who reside and/or work within 20 km from MRRH were enrolled, and thus all women were in close proximity to a facility with family planning services.…”

Section: Study Proceduresmentioning

confidence: 99%

“…Family planning methods are widely available in most public facilities in Uganda, albeit with reported stockouts of some contraceptive methods, particularly the long-acting methods, leading to unwanted pregnancies [12]. Women at risk of or with a history of physical and sexual violence and poor birth outcomes (preterm birth, infant death, stillbirth, low birthweight, complicated pregnancy) have low utilization of postpartum contraception [11].…”

Section: Introductionmentioning

confidence: 99%

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Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

et al. 2019

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Background Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda. Methods and findings We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm 3 (SD = 61) for those enrolled in the control group versus 393 cells/mm 3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67–13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65–12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31–4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66–9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40–9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control ( P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contracepti...

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Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa

McTigue¹,

Swartz²,

Brittain³

et al. 2022

Social Science & Medicine

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The Experience and Impact of Contraceptive Stockouts Among Women, Providers and Policymakers in Two Districts of Uganda

Cited by 17 publications

References 8 publications

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa

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