Selected Data From the Urban Reproductive Health Initiative Surveys: Providers' Self-Reported Restrictions
| Country (Reference) | Sample size | Age | Parity | Marital status |
|---|---|---|---|---|
| Uttar Pradesh, India (Calhoun et al.18) | 1,751 (406 public, 1,345 private) | 30% of doctors restricted access to pills based on a minimum age; more than 70% restricted access to sterilization and IUD based on a minimum age requirement. More than 70% of nurses and midwives restricted the IUD based on a minimum age. Approximately 50% of doctors said they restrict access to injectables based on a minimum age. | 90% of providers restricted access to female sterilization and IUD based on the client's parity. 65% of these doctors required the client to have 1 child, and 63% of TBAs required 2 children for an IUD. Government of India guidelines require that a client have at least 1 child, but 83% of doctors required a client to have at least 2 children for female sterilization. Parity restrictions were imposed for pills by 66% of nurses versus only 20% of doctors and 25% of TBAs. Almost 50% of these providers required that a client have 2 children. | Nearly 99% of doctors restricted access to sterilization based on marital status, which may be related to Government of India guidelines requiring women to be ever-married. Doctors less frequently restricted access to pills (48%), condoms (29%), and injectables (68%). About 50% of nurses and midwives and only 20% of TBAs restricted a client's access to condoms. Pill restrictions based on marital status were also common, at 77% of nurses, 72% of midwives, and 62% of TBAs. |
| Kenya (Tumlinson et al.15) | 676 (291 public, 385 private) | 58% imposed minimum age barriers for 1 or more methods. Minimum age restrictions were commonly imposed on clients seeking injectables, with large numbers refusing to offer injectables to women younger than 20 years. A significantly higher percentage of providers in private facilities imposed minimum age restrictions across all methods (e.g., 55% of private providers vs. 27% public providers for implants and IUDs). | 41% restricted access to 1 or more methods based on parity. Less than 2% of providers restricted access to condoms or EC, and 60% restricted access to female sterilization based on parity. For female sterilization, 46% of providers (among those that offer sterilization and restrict on parity) required a woman to have at least 3 or more children before receiving the method. | 22% of providers will not offer 1 or more methods to unmarried women. Very few providers restricted access to pills, EC, or condoms based on marital status. Approximately 10% reported that they would not provide injectables, IUDs, or implants to unmarried women, and 40% would not provide female sterilization. |
| Nigeria (Schwandt et al.16) | 1,479 health facility providers, 415 pharmacists, 483 patent medicine vendors | Minimum age restrictions ranged between 70% and 93% across method and provider. Restrictions were relatively lower for condoms, EC, and pills (70%–87%), and highest for injectables and IUDs (84%–93%). | Minimum parity restrictions ranged between 3% and 65% across method and provider type. Restrictions were lowest for condoms (3%–6%), followed by EC (12%–20%). Restrictions for injectables were reported by 65% of health facility providers versus 22% of pharmacists. | Marital status restrictions ranged between 7% and 74% across method and provider type. Restrictions based on marital status were lowest for condoms (7%–10%) and EC (17%–26%), and highest for IUDs (67%) and injectables (45%–73%). |
| Senegal (Sidze et al.17) | 637 (516 from public facilities, 121 from private facilities) | Minimum age restrictions were common in the public sector for the pill (57%), injectable (44%), and implant (45%). Restrictions were less common for condoms 25%) and EC (24%). Restrictions were slightly lower for private providers: pill (49%), injectable (41%), implant (38%), condom (20%), and EC (21%). On average, providers in both sectors required clients to be at least 18 for most methods. | Not reported | Between 12% and 14% of public sector providers required that a woman be married to receive the pill, injectable, or implant, and 8%–9% had that requirement for condoms and EC. In private health facilities, 21%–30% of providers did not offer unmarried women the pill, injectable, implant, or EC; 12% did not offer condoms. |
Abbreviations: EC, emergency contraception; IUD, intrauterine device; TBA, traditional birth attendant.