Bridging User & Provider Perspectives: Family Planning Access & Utilization in Rural Mozambique

To examine how the contraceptive behavior of women in rural southern Mozambique is shaped by their individual and household characteristics; community characteristics; access to family planning services; and characteristics of health facilities.

Quantitative and qualitative data were collected mostly between January 20 and December 15, 2011, in rural areas of four districts in Gaza Province, Mozambique. The data included: a retrospective household-based survey of women of reproductive age (the analytical sample consisted of 1554 non-pregnant women in marital union); qualitative interviews with a subsample of surveyed women; a survey of communities where the women resided (n = 56); and a survey of all health facilities in the study area (n = 56). Binomial and multinomial logistic models were fitted to predict current use of modern contraceptive methods. Statistical analyses were complemented by insights from qualitative data.

Positive associations were detected between contraceptive use and education, household wealth, and perceived HIV infection status. Distance to the clinic was negatively associated with contraceptive use. These effects were additive, with some varying by type of contraceptive method. Examination of qualitative data highlighted frequent cognitive dissonance between service providers and users.

A simultaneous consideration of user-level and provider-level perspectives on contraceptive use improves our understanding of contraceptive dynamics and can usefully inform policy.

Table 1

Characteristics of 1554 non-pregnant women in marital union resident in rural areas of four districts of Gaza Province, Mozambique, 2011.a

Characteristic	No.	Distribution	Range
Current contraceptive use (percent)
Currently uses any modern method	357	23.0	0.0–100
Currently uses oral contraception	195	12.5	0.0–100
Currently uses long-term contraception	134	8.6	0.0–100
Age, y (mean)	1554	32.5	21–49
No. of living children (mean)	1554	3.5	0–10
Education level (percent)
No education	397	25.5	0.0–100
1–4 y	703	45.2	0.0–100
≥5 y	455	29.3	0.0–100
Works outside of agriculture (percent)	528	34.0	0.0–100
Does not want children within next 2 years (percent)	980	63.1	0.0–100
Perceived HIV infection status (percent confirmed or suspected HIV+)	640	41.2	0.0–100
Polygamous union (percent)	413	26.6	0.0–100
Husband is a migrant (percent)	547	35.2	0.0–100
Household material conditions, scale of 1 – 4, (mean)	1554	2.1	1–4
Public transportation cost to nearest town, MZN b	1554	50	10–300
Difficulty of getting to the nearest town in the rainy season, scale of 1 – 3, (mean)	1554	1.7	1–3
Distance to nearest clinic, km (mean)	1554	4.9	0.13–17.27
Service index of nearest clinic, scale of 1 – 4 (mean)	1554	2.0	1–4
Cumulative duration that any contraceptives were out of stock in a 12-month period in nearest clinic, wk (mean)	1554	14.0	0–120
Cumulative duration that oral contraceptives were out of stock in a 12-month period in nearest clinic, wk (mean)	1554	8.1	0–120
Cumulative duration that long-term contraceptives were out of stock in a 12-month period in nearest clinic, wk (mean)	1554	2.8	0–30

Abbreviation: MZN, Mozambican metical.

aData were collected mostly between January 20 and December 15, 2011.

bThe exchange rate for 1.00 MZN is approximately US $0.04 at the time of data collection.

Full article at: http://goo.gl/MzFVYb

By: Victor Agadjanian,a,* Sarah R. Hayford,b Luciana Luz,c and Jing Yaod

^aT. Denny Sanford School of Social and Family Dynamics, Center for Population Dynamics, Arizona State University, Tempe, USA

^bDepartment of Sociology and Institute for Population Research, Ohio State University, Columbus, USA

^cCedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

^dUrban Big Data Centre, School of Social and Political Sciences, University of Glasgow, Glasgow, UK

^*Corresponding author at: T. Denny Sanford School of Social and Family Dynamics, Center for Population Dynamics, Arizona State University, 951 S. Cady Mall, Tempe, AZ, 85287-3701, USA. Tel.: +1 480 965 3804; fax: +1 480 965 6779. Email: ude.usa@gav (V. Agadjanian)

   

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