Department of Health Policy and Management, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2020 Jul 23;15(7):e0236018. doi: 10.1371/journal.pone.0236018. eCollection 2020.
Expanding access to family planning (FP) is a principal objective of global family planning efforts and has been a driving force of national family planning programs in recent years. Many country programs are working alongside with the international family planning community to expand access to modern contraceptives. However, there is a challenging need for measuring all aspects of access. Measuring access usually requires linking information from multiple sources (e.g., individual women and facilities). To assess the influence of access to family planning services on modern contraceptive use among women, we link four rounds of individual women and service delivery points survey data from PMA2020 in Kinshasa. Multilevel logistics regression on pooled data is performed to test the influence of facility-level access factors on individual-level contraceptive use. We add variables tailored from a conceptual framework to cover elements of access to family planning: administrative access, geographic or physical access, economic access or affordability, cognitive access, service quality, and psychological access. We find that the effect of community and facility-level access factors varies extensively but having fewer stocked-out facilities and more facilities with long-acting permanent methods (LAPM) increases the odds of using modern contraceptives among women in Kinshasa. Our study shows that reliable supply chain with a broad array of method mix will increase the odds of modern contraceptive use at community level among women in Kinshasa. Using to community-oriented practices and service delivery along with empowering women to make health-related decisions should become a priority of family planning programs and international stakeholders in the country.
扩大计划生育（FP）的可及性是全球计划生育工作的主要目标，也是近年来国家计划生育项目的推动力量。许多国家项目正在与国际计划生育界合作，以扩大现代避孕药具的可及性。然而，衡量可及性的各个方面存在着具有挑战性的需求。衡量可及性通常需要将来自多个来源（例如，个体妇女和设施）的信息联系起来。为了评估计划生育服务可及性对妇女使用现代避孕药具的影响，我们将 PMA2020 在金沙萨的四轮个体妇女和服务提供点调查数据联系起来。对汇总数据进行多层次逻辑回归，以检验设施层面可及性因素对个体层面避孕药具使用的影响。我们添加了根据概念框架量身定制的变量，以涵盖计划生育可及性的各个要素：行政可及性、地理或物理可及性、经济可及性或负担能力、认知可及性、服务质量和心理可及性。我们发现，社区和设施层面可及性因素的影响广泛，但库存不足的设施减少和具有长效永久方法（LAPM）的设施增多，都会增加金沙萨妇女使用现代避孕药具的几率。我们的研究表明，可靠的供应链和广泛的方法组合将增加金沙萨社区层面妇女使用现代避孕药具的几率。以社区为导向的实践和服务提供，以及赋予妇女做出与健康相关的决策的权力，应该成为计划生育项目和国家国际利益相关者的优先事项。
