Pleasants Elizabeth, Koffi Tekou B, Weidert Karen, McCoy Sandra I, Prata Ndola
School of Public Health, University of California at Berkeley, Berkeley, CA, USA.
Cabinet De Recherche Et D'évaluation (CERA), Lomé, Togo.
Open Access J Contracept. 2019 Dec 5;10:79-88. doi: 10.2147/OAJC.S226481. eCollection 2019.
Despite improvements in contraception availability, women face persistent barriers that compromise reproductive autonomy and informed choice. Provider bias is one way in which access to contraception can be restricted within clinical encounters and has been established as common in sub-Saharan Africa. This analysis assessed the prevalence of provider restrictions and the potential impact on women's method uptake in Lomé, Togo.
This sub-analysis used survey data from provider and client interviews collected to assess the impacts of the Agir pour la Planification Familiale (AgirPF) program in Togo. The relationships between provider restrictiveness and women's receipt of their desired method of contraception were modelled using mixed effects logistic regressions looking at all women and among subgroups hypothesized to be at potentially higher risk of bias.
Around 84% of providers reported a restriction in contraceptive provision for the five contraceptive methods explored (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Among all women, there were no significant associations between provider restrictiveness and women's receipt of desired method, including among those who desired long-acting methods. In adjusted modeling, marital status was a covariate significantly associated with desired method, with married women more likely to receive their desired method than unmarried women (aOR 2.73, 95% CI 1.45-5.13).
Provider reports of high levels of restrictions in this population are concerning and should be further explored, especially its effects on unmarried women. However, restrictions reported by providers in this study did not appear to statistically significantly influence contraceptive method received.
尽管避孕措施的可及性有所改善，但女性仍面临持续存在的障碍，这些障碍损害了生殖自主权和知情选择。提供者偏见是在临床诊疗过程中限制避孕措施获取的一种方式，并且在撒哈拉以南非洲地区已被确认为普遍现象。本分析评估了多哥洛美地区提供者限制的发生率及其对女性避孕方法采用的潜在影响。
本亚分析使用了从提供者和服务对象访谈中收集的调查数据，以评估多哥“为计划生育行动”（AgirPF）项目的影响。使用混合效应逻辑回归模型，研究所有女性以及假设存在更高偏见风险的亚组中，提供者的限制性与女性获得其期望避孕方法之间的关系。
约84%的提供者报告在探索的五种避孕方法（口服避孕药、男用避孕套、注射剂、宫内节育器和皮下埋植剂）的提供上存在限制。约53%的提供者报告基于年龄、生育状况、伴侣同意或婚姻状况限制了五种方法中的至少四种。在所有女性中，提供者的限制性与女性获得期望方法之间没有显著关联，包括那些期望长效方法的女性。在调整模型中，婚姻状况是与期望方法显著相关的协变量，已婚女性比未婚女性更有可能获得其期望的方法（调整后比值比2.73，95%置信区间1.45 - 5.13）。
该人群中提供者报告的高度限制令人担忧，应进一步探究，尤其是其对未婚女性的影响。然而，本研究中提供者报告的限制在统计学上似乎并未显著影响所采用的避孕方法。
