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ORIGINAL ARTICLE
Open Access

Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity

Brooke W. Bullington, Nathalie Sawadogo, Katherine Tumlinson, Ana Langer, Abdramane Soura, Pascal Zabre, Ali Sié and Leigh Senderowicz
Global Health: Science and Practice June 2023, 11(3):e2200470; https://doi.org/10.9745/GHSP-D-22-00470
Brooke W. Bullington
aDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
bCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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  • For correspondence: bbullington@unc.edu
Nathalie Sawadogo
cInstitut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso.
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Katherine Tumlinson
bCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
dDepartment of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Ana Langer
eDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Abdramane Soura
cInstitut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso.
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Pascal Zabre
fCentre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
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Ali Sié
fCentre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
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Leigh Senderowicz
eDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
gDepartment of Gender and Women’s Studies, University of Wisconsin-Madison, Madison, WI, USA.
hDepartment of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA.
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Figures & Tables

Tables

    • View popup
    TABLE 1.

    Demographic Characteristics of Sample of Reproductive-Aged Women and Reproductive-Aged Women With Children in Nouna and Ouagadougou, Burkina Faso

    All Reproductive-Aged WomenOnly Reproductive-Aged Women With Children
    Ouagadougou, %
    (n=1,275)
    Nouna, %
    (n=2,654)
    Overall, %
    (n=3,929)
    Ouagadougou, %
    (n=861)
    Nouna, %
    (n=2,054)
    Overall, %
    (n=2,915)
    Age, years
     15–24344340102923
     25–34333132423839
     35–49332728473337
    Married667069938688
    Education
     None375650526662
     Some primary school232424212524
     At least some secondary school36192522913
     Missing401401
    Primary mode of transport
     Foot3211642015
     Bicycle147052147053
     Motorcycle6982869927
     Car1003802
     Other412512
    Number of children
     0352529000
     1–2272928413839
     3–4332930513842
     5+5181382319
    Contraception use
     Never used366052225344
     Previously used301117371219
     Currently using333031413537
    Attended a 45th day postpartum checkup434242635457
    • View popup
    TABLE 2.

    Reported Lifetime Experiences of Provider Encouragement and Discouragement to Use or Not Use Contraception From Reproductive-Aged Women in Nouna and Ouagadougou, Burkina Faso

    OuagadougouNounaOverall
    Among all reproductive-aged womenn=1,275n=2,654n=3,929
     Provider discouraged against using contraceptive method because said you did not have “enough” children1%1%1%
    Among all reproductive-aged women with childrenn=861n=2,054n=2,915
     Provider encouraged to use contraceptive method because said you had “too many” children9%19%16%
    Among reproductive-aged mothers who attended a 45th day postpartum checkupn=545n=1,118n=1,663
    At the 45th day visit
     Was told to just choose a method34%45%41%
     Was asked if you wanted to use contraception first61%31%41%
     Asked for contraception before the provider mentioned it4%15%12%
     Other1%10%7%
    • View popup
    TABLE 3.

    Factors Associated With Provider Encouragement to Use Family Planning Due to a Provider’s Perception of Parity in Nouna and Ouagadougou, Burkina Faso

    Adjusted Odds Ratio (95% CI)
    Age (ref: 15–24 years), years
     25–341.51 (1.11, 2.06)
     35–491.47 (1.05, 2.07)
    Education level (ref: none)
     At least some primary1.16 (0.90, 1.50)
     At least some secondary1.27 (0.85, 1.90)
    Marital status (ref: not married)
     Currently married1.56 (1.08, 2.26)
    Primary mode of transport (ref: foot)
     Bicycle0.89 (0.68, 1.16)
     Motorcycle0.53 (0.36, 0.80)
     Car0.92 (0.37, 2.25)
    Number of children (ref: 1–2)
     3–41.26 (0.97, 1.62)
     5+2.42 (1.76, 3.32)
    Site (ref: Ouagadougou)
     Nouna1.90 (1.30, 2.78)
    Ever had a 45th day postpartum visit (ref: no)
     Had a 45th day postpartum visit2.67 (2.10, 3.37)
    • Abbreviation: CI, confidence interval.

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Global Health: Science and Practice: 11 (3)
Global Health: Science and Practice
Vol. 11, No. 3
June 21, 2023
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Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity
Brooke W. Bullington, Nathalie Sawadogo, Katherine Tumlinson, Ana Langer, Abdramane Soura, Pascal Zabre, Ali Sié, Leigh Senderowicz
Global Health: Science and Practice Jun 2023, 11 (3) e2200470; DOI: 10.9745/GHSP-D-22-00470

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Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity
Brooke W. Bullington, Nathalie Sawadogo, Katherine Tumlinson, Ana Langer, Abdramane Soura, Pascal Zabre, Ali Sié, Leigh Senderowicz
Global Health: Science and Practice Jun 2023, 11 (3) e2200470; DOI: 10.9745/GHSP-D-22-00470
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