The influence of health facility-level access measures on modern contraceptive use in Kinshasa, DRC

PLoS One. 2020 Jul 23;15(7):e0236018. doi: 10.1371/journal.pone.0236018. eCollection 2020.

Abstract

Expanding access to family planning (FP) is a principal objective of global family planning efforts and has been a driving force of national family planning programs in recent years. Many country programs are working alongside with the international family planning community to expand access to modern contraceptives. However, there is a challenging need for measuring all aspects of access. Measuring access usually requires linking information from multiple sources (e.g., individual women and facilities). To assess the influence of access to family planning services on modern contraceptive use among women, we link four rounds of individual women and service delivery points survey data from PMA2020 in Kinshasa. Multilevel logistics regression on pooled data is performed to test the influence of facility-level access factors on individual-level contraceptive use. We add variables tailored from a conceptual framework to cover elements of access to family planning: administrative access, geographic or physical access, economic access or affordability, cognitive access, service quality, and psychological access. We find that the effect of community and facility-level access factors varies extensively but having fewer stocked-out facilities and more facilities with long-acting permanent methods (LAPM) increases the odds of using modern contraceptives among women in Kinshasa. Our study shows that reliable supply chain with a broad array of method mix will increase the odds of modern contraceptive use at community level among women in Kinshasa. Using to community-oriented practices and service delivery along with empowering women to make health-related decisions should become a priority of family planning programs and international stakeholders in the country.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Contraception Behavior / statistics & numerical data*
  • Democratic Republic of the Congo
  • Family Planning Services*
  • Female
  • Humans
  • Logistic Models
  • Middle Aged
  • Surveys and Questionnaires
  • Young Adult

Grants and funding

BMGF is the grant awarded to Tulane University to implement PMA2020 surveys in the DRC. the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.