RESUMEN
BACKGROUND: The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits. METHODS: This study employs a set of methods that includes mystery clients, focus group discussions, key informant interviews, and journey mapping workshops. Using this multi-method approach, we aim to quantify the frequency of method denial resulting from contraceptive stockout and describe the impact of stockouts on the lived experiences of women seeking contraception in Western Kenya. RESULTS: Contraceptives were found to be out of stock in 19% of visits made to health facilities by mystery clients, with all contraceptive methods stocked out in 9% of visits. Women experienced stockouts as a sizeable barrier to accessing their preferred method of contraception and a reason for taking up non-preferred methods, which has dire consequences for heath, autonomy, and the ability to prevent unintended pregnancy. Reasons for contraceptive stockouts are many and complex, and often linked to challenges in the supply chain - including inefficient planning, procurement, and distribution of family planning commodities. CONCLUSIONS: Contraceptive stockouts are frequent and negatively impact patients, providers, and communities. Based on the findings of this study, the authors identify areas where funding and sustained action have the potential to ameliorate the frequency and severity of contraceptive stockouts, including more regular deliveries, in-person data collection, and use of data for forecasting, and point to areas where further research is needed.
Asunto(s)
Anticoncepción , Anticonceptivos , Embarazo , Humanos , Femenino , Kenia , Anticoncepción/métodos , Servicios de Planificación Familiar , Embarazo no Planeado , Conducta AnticonceptivaRESUMEN
Contraceptive stock-outs are a world-wide problem, yet published research on the impacts of contraceptive stock-outs have not been comprehensively reviewed and synthesised. This systematic review highlights findings about the impacts of contraceptive stock-outs on users, providers, and facilities and identifies topics that should be explored to ensure everyone can access their preferred method of contraception. We systematically searched PubMed, Embase, Web of Science, Popline, and JSTOR for studies addressing the impacts of contraceptive stock-outs. Of 435 studies, 25 publications addressed the impacts of contraceptive stock-outs. Only two articles focused solely on contraceptive stock-outs; the remaining studies examined stock-outs alongside other factors that may influence contraceptive service provision. Studies discussed how stock-outs limited individuals' ability to use their preferred contraceptive method, influenced where contraceptive methods were obtained and how much they cost, and limited providers' and facilities' abilities to provide contraceptive care. Comparing the impacts of contraceptive stock-outs across studies was challenging, as reliability of stock was sometimes not distinguished from overall method availability, and studies used variable methods to measure stock-outs. Evidence presented in this review can inform efforts to ensure that preferred contraceptive methods are consistently available and accessible to all.
Asunto(s)
Anticoncepción , Anticonceptivos , Anticoncepción/métodos , Humanos , Reproducibilidad de los ResultadosRESUMEN
Midwives play an important role in maternal and child health in developing countries, but they are rarely involved in providing family planning services, except in Indonesia. This article underscores midwives' crucial role in supplying modern contraceptive methods in Indonesia. Data for this analysis came from eight waves of the Indonesia Demographic and Health Survey (IDHS). The main analysis was confined to 17 216 current users of modern methods from the 2017 IDHS. Midwives delivered contraceptives to 53% of the modern-method users in Indonesia. Multinomial logistic regression showed that the odds of users obtaining their contraceptive supplies from midwives was significantly associated with age, parity, urban-rural location, region, education, wealth, exposure to family planning, and method type. Midwives help to reduce doctors' workload for them to focus on specialized services. Developing countries can learn from the Indonesian experience to ensure equitable access to family planning services.
Asunto(s)
Anticonceptivos , Partería , Niño , Demografía , Países en Desarrollo , Servicios de Planificación Familiar , Femenino , Humanos , Indonesia , EmbarazoRESUMEN
BACKGROUND: The private sector is playing an increasingly important role in family planning services globally. The active participation of private providers is associated with a higher contraceptive prevalence rate. OBJECTIVES: To examine the differentials and determinants of the utilization of private providers for family planning services. METHOD: This study used the 2014 Malaysian Population and Family Survey data. Cross-tabulations and logistic regression were performed on 1,817 current users of modern methods. RESULTS: Overall, 26% of modern method users obtained their supplies from private clinics/pharmacies and 15.2% from other sources, such as drug stores and sundry shops. The odds of utilizing the private sector for family planning services differ significantly across regions and socio-economic groups. The odds of obtaining supply from the private clinics/pharmacies were higher among the Chinese and urban women (AOR > 1), and it was lower among those from the eastern region (AOR = 0.47, 95% CI = 0.30-0.73). Non-Bumiputera, urban, higher educated, and working women, and those whose husbands decided on family planning had higher odds of obtaining the supply from the other sources (AOR > 1). CONCLUSION: The private sector complements and supplements the public sector in providing family planning services to the public.
Asunto(s)
Anticoncepción/métodos , Anticonceptivos/provisión & distribución , Servicios de Planificación Familiar/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Sector Privado , Servicios de Salud para Mujeres/estadística & datos numéricos , Adulto , Conducta Anticonceptiva , Femenino , Humanos , Malasia , Persona de Mediana Edad , Características de la Residencia , Población Rural , Educación Sexual , Factores Socioeconómicos , Población Urbana , Adulto JovenRESUMEN
PURPOSE: To identify and assess factors determining the functioning of supply chain systems for modern contraception in low- and middle-income countries (LMICs), and to identify challenges contributing to contraception stockouts that may lead to unmet need. MATERIALS AND METHODS: Scientific databases and grey literature were searched including Database of Abstracts of Reviews of Effectiveness (DARE), PubMed, MEDLINE, POPLINE, CINAHL, Academic Search Complete, Science Direct, Web of Science, Cochrane Central, Google Scholar, WHO databases and websites of key international organisations. RESULTS: Studies indicated that supply chain system inefficiencies significantly affect availability of modern FP and contraception commodities in LMICs, especially in rural public facilities where distribution barriers may be acute. Supply chain failures or bottlenecks may be attributed to: weak and poorly institutionalized logistic management information systems (LMIS), poor physical infrastructures in LMICs, lack of trained and dedicated staff for supply chain management, inadequate funding, and rigid government policies on task sharing. However, there is evidence that implementing effective LMISs and involving public and private providers will distribution channels resulted in reduction in medical commodities' stockout rates. CONCLUSIONS: Supply chain bottlenecks contribute significantly to persistent high stockout rates for modern contraceptives in LMICs. Interventions aimed at enhancing uptake of contraceptives to reduce the problem of unmet need in LMICs should make strong commitments towards strengthening these countries' health commodities supply chain management systems. Current evidence is limited and additional, and well-designed implementation research on contraception supply chain systems is warranted to gain further understanding and insights on the determinants of supply chain bottlenecks and their impact on stockouts of contraception commodities.