TY - JOUR
T1 - Provider imposed restrictions to clients' access to family planning in urban Uttar Pradesh, India
T2 - A mixed methods study
AU - Calhoun, Lisa M.
AU - Speizer, Ilene S.
AU - Rimal, Rajiv
AU - Sripad, Pooja
AU - Chatterjee, Nilesh
AU - Achyut, Pranita
AU - Nanda, Priya
N1 - Funding Information:
This manuscript was made possible by support from the Bill & Melinda Gates Foundation (BMGF) under terms of the Measurement, Learning & Evaluation for the Urban Reproductive Health Initiative Project (MLE). The author’s views expressed in this publication do not necessarily reflect the views of BMGF. We are grateful to the Carolina Population Center (R24 HD050924) for general support. The authors would like to thank Sukhpal Marwa and Geetali Trivedi for their contributions to this paper. An earlier version of this paper was presented at the International Conference on Family Planning in Dakar, Senegal in November 2011. At the time of writing this paper, Rajiv Rimal was at Center for Communication Programs, Johns Hopkins University, Baltimore, USA.
PY - 2013/12/23
Y1 - 2013/12/23
N2 - Background: Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients' access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods. Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients' access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results: The quantitative findings show that providers restrict clients' access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients' education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions: Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods.
AB - Background: Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients' access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods. Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients' access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results: The quantitative findings show that providers restrict clients' access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients' education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions: Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods.
KW - Eligibility barriers
KW - Family planning
KW - India
KW - Provider barriers
KW - Urban
KW - Uttar Pradesh
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U2 - 10.1186/1472-6963-13-532
DO - 10.1186/1472-6963-13-532
M3 - Article
C2 - 24365015
AN - SCOPUS:84890692464
SN - 1472-6963
VL - 13
JO - BMC health services research
JF - BMC health services research
IS - 1
M1 - 532
ER -