Muhoza Pierre, Koffi Alain K, Anglewicz Philip, Gichangi Peter, Guiella Georges, OlaOlorun Funmilola, Omoluabi Elizabeth, Sodani P R, Thiongo Mary, Akilimali Pierre, Tsui Amy, Radloff Scott
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Health Policy Plan. 2021 Apr 21;36(3):273-287. doi: 10.1093/heapol/czaa197.
Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.
约2.14亿育龄妇女无法获得满足其计划生育需求的足够避孕措施，但避孕措施的可获得模式却很少得到研究。在一些地区，随着对避孕药具需求的不断增长，避孕方法可获得性低和缺货被认为是育龄妇女未满足需求的主要驱动因素，不过这方面的证据有限。在本研究中，我们调查了撒哈拉以南非洲四个国家（布基纳法索、刚果民主共和国、肯尼亚和尼日利亚）以及印度城市地区特定避孕方法的缺货情况、方法可获得性和使用趋势。我们使用了来自行动敏捷项目绩效监测的代表性调查数据，这些数据在按部门（公立与私立）分层的服务提供点（SDP）每季度收集一次，所有国家在2017年至2019年期间有五到六个季度的调查数据。在提供计划生育服务的SDP中，我们计算了每个国家和季度以及按部门提供至少一种现代避孕方法（MCM）的百分比。我们调查了有缺货情况的SDP的百分比趋势，以及目前提供避孕套、紧急避孕、口服避孕药、注射剂、宫内节育器和植入物的SDP的百分比趋势。我们还按季度和国家调查了特定方法的客户就诊趋势以及由此估计的预防怀孕情况。在所有国家中，绝大多数SDP在研究期间至少有一种MCM有库存。我们发现，缺货频率因方法和部门而异，且比之前认为的更具动态性。虽然与其他方法相比，长效可逆避孕方法（LARC）在各国的可获得性和分布有限，但LARC在夫妇年保护中始终占更大比例。我们讨论了研究结果，这些结果表明了私营部门在实现全球和国家计划生育目标方面的重要性。
