PT  - JOURNAL ARTICLE
AU  - Katherine Tumlinson
AU  - Ilene S Speizer
AU  - Linda H Archer
AU  - Frieda Behets
TI  - Simulated clients reveal factors that may limit contraceptive use in Kisumu, Kenya
AID  - 10.9745/GHSP-D-13-00075
DP  - 2013 Nov 01
TA  - Global Health: Science and Practice
PG  - 407--416
VI  - 1
IP  - 3
4099  - http://www.ghspjournal.org/content/1/3/407.short
4100  - http://www.ghspjournal.org/content/1/3/407.full
SO  - GLOB HEALTH SCI PRACT2013 Nov 01; 1
AB  - While the quality of family planning service delivery was often good, clients reported barriers including: excessively long waiting times, provider absences, informal fees, inappropriate pregnancy tests, misinformation, and provider disrespect. Improved monitoring and oversight of facility practices and examination of provider needs and motivations may increase quality of service. A better understanding of the factors influencing use of family planning has the potential to increase contraceptive prevalence and improve the ability of women and their partners to freely choose the number and spacing of their children. Investigations into factors contributing to unmet need frequently rely on data collected using household surveys or interviews with family planning clients and providers. Our research utilizes qualitative information resulting from simulated client visits to investigate programmatic barriers to contraceptive use in a sample of 19 health care facilities in Kisumu East District, a city in western Kenya. Simulated client reports indicate deficiencies in provider competence as well as tenuous relations between providers and clients. In addition, simulated client data reveal occasional absences of providers during normal facility hours of operation and requests of informal fees for services. Trainings that address specific gaps in provider medical knowledge and counseling skills as well as client-provider relations may reduce such programmatic barriers to contraceptive use. In addition, improved supervision and oversight at facilities may increase physical and financial access to services. Future research investigating provider motivations may illuminate root causes of programmatic barriers.