Carolina Population Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America.
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America.
Hum Resour Health. 2022 Jan 29;20(1):13. doi: 10.1186/s12960-022-00712-5.
Financial access to family planning (FP) is essential to the health and well-being of women in Tanzania. Tanzanian policy dictates that FP methods and services obtained at public facilities are provided for free. However, public sector FP is no longer free when providers solicit informal payments. In this analysis, we investigate the prevalence and amount of informal payments for FP in Tanzania.
We used data from the 2015-2016 Tanzania Demographic and Health Survey to investigate whether informal payments for FP had been effectively eliminated by this policy.
We found that, at public sector facilities, the majority (84.6%) of women received their current FP method for free (95% confidence interval (CI): 81.9, 87.3), but this proportion varied meaningfully by facility and method type. Injectable contraception was the most commonly used method by women in the lowest wealth quintiles and was most frequently sought by these women from a government dispensary. One in four women (25.8%) seeking injectable contraception from government dispensaries reported paying a fee (95% CI: 19.5, 32.1). Among injectable users who reported payment for their current method, the mean cost at public sector facilities was 1420 Tanzanian Shillings (TSh) and the mean cost at private sector facilities was TSh 1930 (approximately 0.61 United States Dollars (USD) and 0.83 USD, respectively). Among implant users who reported payment for their current method, the mean cost at public sector facilities was TSh 4127 and the mean cost at private sector facilities was TSh 6194 (approximately 1.78 USD and 2.68 USD, respectively).
These findings suggest that the majority of women visiting public facilities in Tanzania did not pay informal payments for FP methods or services; however, informal payments at public facilities did occur, varying by facility and method type. Adherence to existing policies mandating free FP methods and services at public facilities, especially government dispensaries, is critical for ensuring contraceptive access among the most economically vulnerable women.
在坦桑尼亚，获得计划生育（FP）的财务支持对妇女的健康和福祉至关重要。坦桑尼亚的政策规定，在公共设施获得的 FP 方法和服务是免费提供的。然而，当提供者索取非正式付款时，公共部门的 FP 不再免费。在这项分析中，我们调查了坦桑尼亚 FP 非正式付款的流行率和金额。
我们使用 2015-2016 年坦桑尼亚人口与健康调查的数据来调查这项政策是否有效消除了 FP 的非正式付款。
我们发现，在公共部门设施中，大多数（84.6%）女性免费获得了她们目前的 FP 方法（95%置信区间（CI）：81.9，87.3），但这一比例因设施和方法类型而有很大差异。在最贫穷的五分之一的女性中，注射避孕是最常用的方法，而且这些女性最常从政府药房寻求这种方法。每四个寻求政府药房注射避孕的女性中就有一个（25.8%）报告支付了费用（95%CI：19.5，32.1）。在报告为当前方法支付费用的注射避孕使用者中，公共部门设施的平均费用为 1420 坦桑尼亚先令（TSh），私营部门设施的平均费用为 TSh 1930（约 0.61 美元和 0.83 美元，分别）。在报告为当前方法支付费用的植入使用者中，公共部门设施的平均费用为 TSh 4127，私营部门设施的平均费用为 TSh 6194（分别约为 1.78 美元和 2.68 美元）。
这些发现表明，在坦桑尼亚访问公共设施的大多数女性没有为 FP 方法或服务支付非正式付款；然而，非正式付款确实发生在公共设施，这取决于设施和方法类型。坚持现有的政策，要求在公共设施，特别是政府药房免费提供 FP 方法和服务，对于确保最经济弱势妇女的避孕措施至关重要。
