Selected Data From the Urban Reproductive Health Initiative Surveys: Providers' Self-Reported Restrictions

Country (Reference)Sample sizeAgeParityMarital status
Uttar Pradesh, India
(Calhoun et al.18)
(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.
(Tumlinson et al.15)
(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.
(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%).
(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 reportedBetween 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.