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Are Women In Lomé Getting Their Desired Methods Of Contraception? Understanding Provider Bias From Restrictions To Choice

Authors Pleasants E, Koffi TB, Weidert K, McCoy SI, Prata N

Received 8 August 2019

Accepted for publication 10 October 2019

Published 5 December 2019 Volume 2019:10 Pages 79—88


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Igal Wolman

Elizabeth Pleasants,1 Tekou B Koffi,2 Karen Weidert,1 Sandra I McCoy,1 Ndola Prata1

1School of Public Health, University of California at Berkeley, Berkeley, CA, USA; 2Cabinet De Recherche Et D’évaluation (CERA), Lomé, Togo

Correspondence: Ndola Prata
School of Public Health, University of California at Berkeley, 2121 Berkeley Way West, #6142, Berkeley, CA 94720, USA
Tel +1 510-642-6915

Background: Despite improvements in contraception availability, women face persistent barriers that compromise reproductive autonomy and informed choice. Provider bias is one way in which access to contraception can be restricted within clinical encounters and has been established as common in sub-Saharan Africa. This analysis assessed the prevalence of provider restrictions and the potential impact on women’s method uptake in Lomé, Togo.
Methods: This sub-analysis used survey data from provider and client interviews collected to assess the impacts of the Agir pour la Planification Familiale (AgirPF) program in Togo. The relationships between provider restrictiveness and women’s receipt of their desired method of contraception were modelled using mixed effects logistic regressions looking at all women and among subgroups hypothesized to be at potentially higher risk of bias.
Results: Around 84% of providers reported a restriction in contraceptive provision for the five contraceptive methods explored (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Among all women, there were no significant associations between provider restrictiveness and women’s receipt of desired method, including among those who desired long-acting methods. In adjusted modeling, marital status was a covariate significantly associated with desired method, with married women more likely to receive their desired method than unmarried women (aOR 2.73, 95% CI 1.45–5.13).
Conclusion: Provider reports of high levels of restrictions in this population are concerning and should be further explored, especially its effects on unmarried women. However, restrictions reported by providers in this study did not appear to statistically significantly influence contraceptive method received.

Keywords: provider bias, provider restrictions, contraception, Togo

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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