Background
Methods
Literature review
Inclusion criteria
Key informant interviews
Results
A description of documents reviewed and key informants
Variable | Frequency (N) |
---|---|
Types of Documents reviewed
| 25 |
Program documents | 7 |
Research articles | 7 |
Policy documents | 3 |
Issue/policy briefs | 3 |
Working papers | 2 |
Others (book chapter, block, fact sheet) | 3 |
Key informants
| |
Sex
| |
Male | 10 |
Female | 15 |
Education level
| |
Master's degree and above | 22 |
Undergraduate degree and below | 3 |
Conceptualization of equity in FP programs and policies
“Individuals have the ability to access quality, comprehensive contraceptive information and services free from discrimination, coercion and violence” [35]“Achieving universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programs" [36]
Author and date | Equity definitions | Dimension | Measurement Outcomes |
---|---|---|---|
Shannon et al., 2020 | Elimination discrimination against women and girls, eradicate violence in both public and private spheres and achieve universal access to sexual and reproductive health (SRH) services | Social, environmental | Method choice |
Linnea, 2016 | Differences in accessing FP based on: living in urban or rural areas, education, gender, ethnicity, religious affiliation, and income | None | Unmet need, Access to contraceptive information, social acceptance of contraceptives |
Clark and Goodhart, 2016 | None | None | None |
Wright et al., 2017 | Individuals have the ability to access quality, comprehensive contraceptive information and services free from discrimination, coercion and violence | Social, other | Access to quality FP |
Guttmacher Institute, 2017 | None | Social, economic, Environmental | Unmet need for FP, Un intended pregnancies, Access to providers |
Bellows et al., 2017 | Expanding FP access to the disadvantaged populations | Social, economic, Environmental | Contraceptive use, Un intended pregnancies |
USAID, 2016 | None | Social, economic, Environmental | Fertility desires, contraceptive use |
Koseki and Klein, 2018 | Access to FP to marginalized rural and poor populations | Economic, Environmental | Unmet need for family planning, FP method use by choice |
Track20, 2015 | None | Other | Modern contraceptive use |
PMA2020, 2014 | None | Social, economic and Environmental | Demand satisfied, Un met need, Contraceptive method mix, Contraceptive prevalence rate(CPR) Unintended birth FP method by choice, Total fertility rate(TFR), Access to information, Satisfaction with provider |
Creanga et al., 2011 | Inequity exists when people are unfairly deprived of something they want or require to protect them from an unwanted or undesirable condition | Economic | Met Need for FP |
Namasivayam et al., 2019 | None | Social, Economic | Contraceptive use |
UNFPA, 2017 | Universal access to sexual and reproductive health services | Social, Economic, and Environmental | Teenage child bearing, CPR |
UNFPA, 2015 | Implicitly as geographical disparities in CPR and high unmet need for FP among young people | Social, Environmental | CPR, Unmet need for FP |
UNFPA, 2017 | Implied as expanding access to FP in remote and hard to reach areas | Social and Environmental | Unmet need for FP, TFR, Access to FP |
USAID, 2018 | Directing FP interventions where they are needed most | Social, Environmental | TFR, Teenage pregnancy |
UBOS and ICF, 2018 | None | Social, Environmental and Economic | Use of contraception, Unmet need for FP, Contact with FP providers, Decision making about FP, Informed choice, TFR, Teenage pregnancy, Desire for a child/to limit birth, Unwanted birth |
Kalangwa and Chelimo, et al., 2018 | The extent to which different socio-economic strata affect access and use of FP products and services | Social, economic and Environmental | Use of FP, Unmet need for FP |
Akol et al., 2014 | Access to FP in hard to reach | Environmental | FP Use |
MOH, 2014 | Access to family planning without discrimination, coercion, or violence | Social, economic and Environmental | Un met need for FP, TFR, mCPR, Access to FP |
MOH, 2015 | Universal access to sexual and reproductive health care services, including family planning, information and education | None | TFR, CPR, Unmet need for FP |
Ssengooba et al., 2017 | None | Social, economic and environmental | Use of contraceptives, unmet need for FP, TFR, discontinuation of contraceptives |
Partners in Population and Development, 2017 | Universal access to reproductive health, including family planning services | Environmental | Unmet need for FP, Total fertility rate, mCPR |
NDPII, 2015 | Universal access to FP | None | Child bearing, Teenage pregnancy, unmet need for FP, Fertility rate |
MOH, 2018 | Geographical access to FP interventions | Social and environmental | Contraceptive use |
“Parallel disparities in fertility and in contraceptive use found between poor and wealthy women” [30]
“Equity includes disparities in the FP indicators between rural and urban” [37]
“Inequity refers to differences in accessing FP based on: living in urban or rural areas, education, gender, ethnicity, religious affiliation, and income” [34]
“The question is how should equity be defined, measured and assessed? Is it just about who is left behind? Is equity measured right? Should it be expanded? ... we need to define the dimensions of focus and have all FP partners agree on the definition” (KI-Development Partner).
“Most FP programs do not focus on equity. The programs are generic without addressing those in most need. The rural are being left out in designing and accessing FP services compared to the urban dwellers” (KI-National Level)
“When MoH is doing FP programming, we focus on equity and the ministry is trying to reach the rural areas with FP services using VHTs and drug shops and other measures like national health insurance and total market approach which are in the pipeline” (KI-National level)
“Equity is a key focus and there is deliberate effort to subsidize services dependent on the population purchasing power. Also, interventions are selected based on understanding of target population and the need. We are specifically targeting the young, the poor and the disabled and regions of priority such as Karamoja” (KI-Development Partner)
Measurement and assessment of equity
Dimensions of equity
Dimension | Items/Indicators | Number of documents (N = 25) |
---|---|---|
Geographical | Residence-rural/urban, regions North/Karamoja, Hard to reach/remote, across countries | 19 |
Socio demographics | sex, age, marital status, parity, ethnicity, religion | 17 |
Economic | Wealth quintiles, poor/rich | 12 |
Women empowerment | employed/working vs house wife [23] | 3 |
Others | New/continuing FP user, place of birth (facility/home) [44] | 2 |
Multidimensional assessment of equity
Outcomes used to measure equity
Data sources for measuring equity
Constraints to achieving equity in FP programs and policies
Implementation Constraints | Client Constraints | Policy Constraints |
---|---|---|
1. Lack of quality comprehensive FP services, characterized by frequent stock outs, long distances to health facilities reflecting poor physical access of facilities, scope of services that does not meet the needs of marginalized populations including adolescents 2. Limited access to postpartum family planning (PPFP) for both home and facility deliveries 3. Lack of male involvement in supporting some women to take up FP 4. Weak inter-ministerial and partner coordination to provide FP to high burden and hard-to-reach populations including (refugees, young girls, islands and mountainous settings 5. The long-acting reversible contraception and permanent methods are not closer to clients 6. Ineffective supply and distribution chain of FP commodities 7. Lack of commodity and service delivery mapping to track the availability of commodities at the facility level 8. Inadequate number of skilled providers and poor attitudes which limits access to wide range of methods 9. Inadequate funding for equitable family planning 10. Generic FP programs without considering the needs of underserved populations 11. Uneven distribution of FP programs and partners | 1. The socio-cultural factors-myths and misconceptions, religious values and gender inequality in rural communities 2. Limited contraceptive information targeting the young people, rural women and men 3. The high client out of pocket payments in the private sector and high cost of LARC hinder the rural poor from accessing FP services | 1. The National and health sector development plan II and other FP policy documents have less focus on equity 2. There are no well-designed sector-specific policies and programs on gender to facilitate equitable access to SRH information and services 3. Inequities in FP use have received little national acknowledgement and attention from health policy-makers 4. Lack of multi-sectoral approach to implement the National Adolescent Health Policy Action Plan 5. Policies and plans are not effectively implemented to address 6. Limited understanding of FP national policies by the implementers |
Implementation constraints to achieving equity
“You find that some districts have more FP partners who end up duplicating services while others don’t have any single partners implementing FP. How shall we achieve equity in that instance? Some groups such as persons with disability, young people, rural and slum areas have no specific interventions focusing on them” (KI-Development partner)
Clients’ constraints to achieving equity
“The peasant farmers in rural areas who are the majority also spend most of the time in garden, hence miss out on FP information on radios” (KI-Sub National Level)