Tumlinson Katherine, Okigbo Chinelo C, Speizer Ilene S
Office of Population Research at Princeton University, Princeton, NJ 08544, USA.
Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Contraception. 2015 Aug;92(2):143-51. doi: 10.1016/j.contraception.2015.04.002. Epub 2015 Apr 11.
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.
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.
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 20 years. Forty-one percent of providers reported that they would not offer one or more methods to nulliparous women and more than one in four providers reported that 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.
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.
更好地了解服务提供者对计划生育设置的障碍的普遍程度，可为旨在增加避孕药具使用的项目提供参考。本研究基于肯尼亚城市的数据，描述了服务提供者自我报告的与客户年龄、生育状况、婚姻状况和第三方同意相关的限制频率，并考虑了机构类型和培训对限制做法的影响。
经过培训的数据收集者对肯尼亚五个城市273个医疗机构的676名服务提供者进行了访谈。向服务提供者询问了他们的背景和培训情况，还询问了提供计划生育服务的年龄、婚姻、生育或同意要求。
超过一半的提供者（58%）报告对一种或多种方法设置了最低年龄限制。这些限制通常针对寻求注射剂的客户，注射剂在肯尼亚城市是一种常用方法，大量提供者拒绝为20岁以下的女性提供注射剂。41%的提供者报告称，他们不会为未生育的女性提供一种或多种方法，超过四分之一的提供者报告称，他们不会为没有至少一个孩子的女性提供注射剂。私立机构的提供者在所有方法类型上设置障碍的可能性显著更高，而那些没有接受过计划生育服务在职培训的提供者在大多数方法上设置生育、婚姻和同意障碍的比例显著更高。
项目需要解决服务提供者设置的障碍，这些障碍减少了获得避孕方法的机会，尤其是在年轻、低生育和单身女性中。有前景的策略包括针对私立机构的提供者，并提高在职培训的普及率。
