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Bias in Contraceptive Provision to Young Women Among Private Health Care Providers in South West Nigeria

CONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in Sout... Full description

Journal Title: International family planning perspectives 2018-03-01, Vol.44 (1), p.19-29
Main Author: Sieverding, Maia
Other Authors: Schatzkin, Eric , Shen, Jennifer , Liu, Jenny
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Guttmacher Institute
ID: ISSN: 1944-0391
Link: https://www.ncbi.nlm.nih.gov/pubmed/30028307
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title: Bias in Contraceptive Provision to Young Women Among Private Health Care Providers in South West Nigeria
format: Article
creator:
  • Sieverding, Maia
  • Schatzkin, Eric
  • Shen, Jennifer
  • Liu, Jenny
subjects:
  • Adolescent
  • Adolescents
  • Adult
  • Attitude of Health Personnel
  • Attitudes
  • Bias
  • Birth control
  • Clients
  • Comparative analysis
  • Condoms
  • Contraception
  • Contraception - methods
  • Contraception - psychology
  • Contraception Behavior
  • Contraceptive Agents - therapeutic use
  • Contraceptives
  • Contraceptives industry
  • Counseling
  • Discrimination in medical care
  • Evidence-based medicine
  • Family planning
  • Family Planning Services
  • Female
  • Fertility
  • Global health
  • Health aspects
  • Health facilities
  • Health Personnel - psychology
  • Health services
  • Humans
  • Injectable contraceptives
  • Intervention
  • Interviews
  • Interviews as Topic
  • Marital status
  • Marriage - psychology
  • Medical care
  • Medical personnel
  • Methods
  • Nigeria
  • Oral contraceptives
  • Parity
  • Pharmacies
  • Pregnancy
  • Pregnancy in Adolescence
  • Private medical care
  • Private Sector
  • Quality
  • Quality management
  • Quality of care
  • Recommendations
  • Reproductive health
  • Restrictions
  • Side effects
  • Single Person - psychology
  • Single status
  • Single women
  • Social aspects
  • Social marketing
  • Sociocultural factors
  • Usage
  • Vignettes
  • Visits
  • Women
  • Womens health
  • Young Adult
  • Young adults
  • Young women
ispartof: International family planning perspectives, 2018-03-01, Vol.44 (1), p.19-29
description: CONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. RESULTS: In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. CONCLUSIONS: Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1944-0391
fulltext: fulltext
issn:
  • 1944-0391
  • 1944-0405
  • 1943-4154
url: Link


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descriptionCONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. RESULTS: In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. CONCLUSIONS: Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.
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languageeng
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subjectAdolescent ; Adolescents ; Adult ; Attitude of Health Personnel ; Attitudes ; Bias ; Birth control ; Clients ; Comparative analysis ; Condoms ; Contraception ; Contraception - methods ; Contraception - psychology ; Contraception Behavior ; Contraceptive Agents - therapeutic use ; Contraceptives ; Contraceptives industry ; Counseling ; Discrimination in medical care ; Evidence-based medicine ; Family planning ; Family Planning Services ; Female ; Fertility ; Global health ; Health aspects ; Health facilities ; Health Personnel - psychology ; Health services ; Humans ; Injectable contraceptives ; Intervention ; Interviews ; Interviews as Topic ; Marital status ; Marriage - psychology ; Medical care ; Medical personnel ; Methods ; Nigeria ; Oral contraceptives ; Parity ; Pharmacies ; Pregnancy ; Pregnancy in Adolescence ; Private medical care ; Private Sector ; Quality ; Quality management ; Quality of care ; Recommendations ; Reproductive health ; Restrictions ; Side effects ; Single Person - psychology ; Single status ; Single women ; Social aspects ; Social marketing ; Sociocultural factors ; Usage ; Vignettes ; Visits ; Women ; Womens health ; Young Adult ; Young adults ; Young women
ispartofInternational family planning perspectives, 2018-03-01, Vol.44 (1), p.19-29
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descriptionCONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. RESULTS: In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. CONCLUSIONS: Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.
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38Methods
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47Quality
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50Recommendations
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52Restrictions
53Side effects
54Single Person - psychology
55Single status
56Single women
57Social aspects
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abstractCONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. RESULTS: In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. CONCLUSIONS: Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.
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