This study has explored how quality issues in delivering family planning services
(supply side), and attitudinal and behavioural issues of the potential users (demand
side) merge together to influence adoption of family planning methods. The subject was
explored by blending Bruce’s (1990) quality of care of family planning services
framework with an access framework with five determinants of decisions to use and
sustain family planning services (availability, accessibility, affordability, adequacy, and
acceptability of the services). Two districts, Misungwi and Ukerewe in Mwanza region,
one of the regions with the lowest contraceptive prevalence rates, were used as case
studies. Data were collected from providers of health services, clients of family planning
services, and men and women non-users in catchment areas of the sampled health
facilities.
The study finds that although family planning services are generally available, the
range of options available to users at the primary healthcare level tends to be limited,
which limits the ability of users to switch methods. Proper management of clients,
including protection of clients’ privacy and ensuring that necessary tests and
counselling are done before any method is prescribed, was also found to be weak. On
the demand side, inadequate information on modern contraceptives (benefits, efficacy,
side effects, and how to deal with them), misunderstandings on possible side effects,
distrust among spouses, and problems of male inclusion stand out as important
constraints to adoption.
Delivery of comprehensive and appropriately packaged information to communities
through properly designed social marketing campaigns, as well as deliberate efforts to
ensure inclusive integrated services at primary healthcare level, can considerably help
boost adoption. Improving the technical competence, in terms of infrastructure to allow
for privacy in service delivery and skills to manage clients appropriately, is essential.
The potential of community health workers in delivering services like injectable
contraceptives should also be tapped.