Do Service Providers in Tanzania Unnecessarily Restrict Clients' Access to Contraceptive Methods?

Context: Even where family planning services are physically accessible and economic barriers to access are few, medical barriers to contraceptive services - such as overspecialization, eligibility restrictions, process hurdles and provider bias - can limit women's use of services. Methods: Data from the 1996 Tanzania Service Availability Survey are used to analyze the prevalence of medical barriers by type of provider, by type of facility and by urban-rural location. Results: Relatively high proportions of providers restrict eligibility by age, particularly for oral contraceptives, the most widely used method among Tanzanian women. Between 79% and 81% of medical aides, trained midwives, maternal and child health aides and auxiliary staff (the most common types of family planning service providers in rural Tanzania) impose age restrictions for the pill. Among all providers, 10-13% report that there is at least one modem method they would never recommend, and 13% report having sent a client home until her next menses, an inappropriate process hurdle for the provision of most hormonal methods. In the aggregate, these restrictions severely limit access to contraceptives for certain groups of women. For example, young, unmarried women who are not menstruating at the time of their visit would encounter one or more barriers or process hurdles at more than 70% of urban facilities and at 80% of rural facilities. Conclusions: If preservice and in-service training and supervisory visits placed greater emphasis on compliance with the Tanzanian National Family Planning Program's service guidelines and standards, providers' unnecessary restrictions on contraceptive use might be reduced, and ultimately eliminated.