Women in urban Senegal seek less biased contraceptive access

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New UNC research has found that women in urban Senegal seeking family planning services tend to avoid providers with a bias that would prevent them from acquiring their preferred method of contraception.

While many studies have exposed the types of biases that those seeking contraception might encounter, including those based on age, marital status, and the number of previous births, this is the first study to examine the effects of those biases on where services are obtained.

Dr. Ilene Speizer

Ilene Speizer, Ph.D., professor of maternal and child health at the UNC Gillings School of Global Public Health, reports that these findings, while consistent in showing that provider bias exists, also show that women base their health-seeking decision-making on bias and the quality of services available.

The study, led by Speizer, was recently published in Studies in Family Planning and was co-led by David Guikey, Ph.D., Boshamer Distinguished Professor of economics, and research associates Jennifer Winston, Ph.D., and Lisa Calhoun, MPH, from the Carolina Population Center.

Senegal made an early commitment to Family Planning 2020, a global initiative to help women and girls around the world gain access to contraception when they need it, and through that has aimed to reduce barriers and increase contraceptive use from 12% to 45% nationwide.

Provider bias is an important barrier to contraceptive access in Senegal. In hospitals, public and private clinics, and pharmacies, those who provide family planning services may refuse to see clients based on preconceived perspectives or societal norms. They may refuse to provide contraception to those who are unmarried, do not have consent from their partner, or do not have children.

At the time the study’s data was collected in 2015, contraceptive use was highest among those who were married, aged 30-44, and living in urban areas. Most obtained their contraception from publicly funded clinics.

As part of an analysis of survey data from women, health facilities, and providers, the study team matched users of family planning services with the facilities they chose to visit. Previous research has shown that because social networks and information exchange impact perceptions of healthcare facilities, women are likely aware of the places where they are most likely to encounter bias.

Results suggest that women avoided providers who showed biases based on age, number of previous births, and marital status. Some traveled further from home to find a provider that exhibited fewer of these biases.

Provider bias was less common in publicly funded facilities. While an overwhelming majority of women chose to visit public facilities, the researchers could not determine from the data whether this was due to reduced bias or greater accessibility of family planning services at these clinics.

While results demonstrated that private facilities had greater consent bias, the analysis showed that women did not avoid facilities where partner consent was required. This may reflect a preference for these private facilities among a small portion of women unrelated to other biases or quality experiences at these sites.

“The information from this study can be used to inform strategies to strengthen family planning services through training of providers and ensuring that they are offering a full range of methods to all clients who visit their facility,” Speizer says. “Once services have been strengthened, it is crucial to spread the word about service improvements so that women and their families are more likely to visit facilities that previously they avoided.