Journal of Urban Health

, Volume 91, Issue 1, pp 186–210 | Cite as

Assessing Gaps and Poverty-Related Inequalities in the Public and Private Sector Family Planning Supply Environment of Urban Nigeria

  • Jessica K. LevyEmail author
  • Sian Curtis
  • Catherine Zimmer
  • Ilene S. Speizer


Nigeria is the most populous country in Africa, and its population is expected to double in <25 years (Central Intelligence Agency 2012; Fotso et al. 2011). Over half of the population already lives in an urban area, and by 2050, that proportion will increase to three quarters (United Nations, Department of Economic and Social Affairs, Population Division 2012; Measurement Learning & Evaluation Project, Nigerian Urban Reproductive Health Initiative, National Population Commission 2012). Reducing unwanted and unplanned pregnancies through reliable access to high-quality modern contraceptives, especially among the urban poor, could make a major contribution to moderating population growth and improving the livelihood of urban residents. This study uses facility census data to create and assign aggregate-level family planning (FP) supply index scores to 19 local government areas (LGAs) across six selected cities of Nigeria. It then explores the relationships between public and private sector FP services and determines whether contraceptive access and availability in either sector is correlated with community-level wealth. Data show pronounced variability in contraceptive access and availability across LGAs in both sectors, with a positive correlation between public sector and private sector supply environments and only localized associations between the FP supply environments and poverty. These results will be useful for program planners and policy makers to improve equal access to contraception through the expansion or redistribution of services in focused urban areas.


Family planning Supply environment Access Availability Inequality Wealth distribution Urban Supply Contraception Service distribution Poverty Nigeria Public-sector Private-sector Community-level 



The data for this research were made possible by the support from the Bill & Melinda Gates Foundation (BMGF) under the terms of the Measurement, Learning & Evaluation for the Urban Reproductive Health Project (MLE). The author’s views expressed in this publication do not necessarily reflect the views of BMGF or the MLE project. The authors would also like to thank Meghan Corroon for her insights into the data collection and analysis process, as well as Karen Foreit, Ph.D., and Herbert Peterson, M.D., for their review of earlier versions of the paper.


  1. 1.
    Central Intelligence Agency. The world factbook. (2012). Accessed March 2012.
  2. 2.
    Fotso JC, Ajayi JO, Idoko EE, et al. Family planning and reproductive health in urban Nigeria: levels trends and differentials. MLE Technical Working Paper 2-2010. Measure, Learning & Evaluation Project; 2011.Google Scholar
  3. 3.
    United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2010 revision, highlights and advance tables. (2011). Accessed February 2012.
  4. 4.
    Measurement Learning & Evaluation Project, Nigerian Urban Reproductive Health Initiative, National Population Commission. 2010–2011 Nigeria baseline survey for the Urban Reproductive Health Initiative. (2012). Accessed March 2012.
  5. 5.
    United Nations Statistics Division, Department of Economic and Social Affairs, United Nations. Millennium development goals indicators: the official United Nations site for the MDG indicators. (2012). Accessed February 2013.
  6. 6.
    World Health Organization Centre for Health Development UNHSP. Hidden cities: unmasking and overcoming health inequities in urban settings. (2010). Accessed February 2013.
  7. 7.
    Brockerhoff MA. An urbanizing world. Popul Bull. 2000; 55(3): 1–44.Google Scholar
  8. 8.
    Ezech AC, Kodzi I, Emina J. Reaching the urban poor with family planning services. Stud Fam Plan. 2010; 41(2): 109–116.CrossRefGoogle Scholar
  9. 9.
    National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria demographic and health survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro; 2009.Google Scholar
  10. 10.
    Bongaarts J. A framework for analyzing the proximate determinants of fertility. Popul Dev Rev. 1978; 4(11): 104–132.Google Scholar
  11. 11.
    Nigeria National Population Commission. Population policy and action. (2012). Accessed January 2013.
  12. 12.
    Winfrey W, Heaton L, Fox T, Adamchak S. Factors influencing the growth of the commercial sector family planning service provision. The POLICY Project Working Paper No. 6. Washington, DC: The Futures Group International; 2000.Google Scholar
  13. 13.
    Khan S, Mishra V, Arnold F, Abderrahim N. Contraceptive trends in developing countries. DHS Comparative Reports No. 16. Calverton, MD: Macro International; 2007.Google Scholar
  14. 14.
    Speizer IS, Nanda P, Achyut P, Pillai G, Guilkey DK. Family planning use among urban poor women from six cities of Uttar Pradesh, India. J Urban Health. 2012. doi: 10.1007/s11524-011-9667-1.PubMedGoogle Scholar
  15. 15.
    Stephenson R, Hennink M. Barriers to family planning service use among the urban poor in Pakistan. Opportunities and Choices Working Paper No. 2; 2004.Google Scholar
  16. 16.
    Kongsri S, Limwattananon S, Sirilak S, Prakongsai P, Tangcharoensathien V. Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey data, 2006 and 2009. Reprod Health Matters. 2011; 19(37): 86–97.PubMedCrossRefGoogle Scholar
  17. 17.
    Foreit K. Addressing poverty: a guide for considering poverty-related and other inequities in health. USAID and MEASURE evaluation. (2012).
  18. 18.
    Sedgh G, Hussain R, Bankole A, Singh S. Women with an unmet need for contraception in developing countries and their reasons for not using a method. Occasional Report No. 37. New York: Guttmacher Institute; June 2007.Google Scholar
  19. 19.
    Gillespie D, Ahmed S, Tsui A, Radloff S. Unwanted fertility among the poor: an inequity? Bull World Health Organ. 2007; 85: 100–107.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Federal Government of Nigeria. Health policy project. RAPID: the change we seek, Nigeria. (2011). Accessed January 2013.
  21. 21.
    Guengant J-P, May J. Proximate determinants of fertility in sub-Saharan Africa and their possible use in fertility projections. United Nations, Department of Economic and Social Affairs, Expert Paper No. 2011/13. Paper presented at the United Nations Expert Group Meeting on Completing the Fertility Transition, New York; 2011.Google Scholar
  22. 22.
    Ogbaje E, Igharo E. Contraceptive security in Nigeria: assessing strengths and weaknesses. USAID | DELIVER PROJECT, Task Order 1. Arlington, MD: USAID; 2009.Google Scholar
  23. 23.
    SHOPS Project, USAID. Nigeria private health sector assessment. Brief. Strengthening Health Outcomes through the Private Sector Project, Abt Associates. Bethesda: USAID; 2012.Google Scholar
  24. 24.
    Sharma S, Dayaratna V. Creating conditions for greater private sector participation in achieving contraceptive security. Health Policy. 2005; 71: 347–357.PubMedCrossRefGoogle Scholar
  25. 25.
    Peters DH, Mirchandani GG, Hansen PM. Strategies for engaging the private sector in sexual and reproductive health: how effective are they? Health Policy Plan. 2004; 19(Suppl. 1): i5–i21.PubMedCrossRefGoogle Scholar
  26. 26.
    Berman P, Rose L. The role of private providers in maternal and child health and family planning services in developing countries. Health Policy Plan. 1996; 11(2): 142–155.PubMedCrossRefGoogle Scholar
  27. 27.
    Patouillard E, Goodman CA, Hanson KG, Mills AJ. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. Int J Equity Health. 2007;6:17.Google Scholar
  28. 28.
    Montagu D, Prata N, Campbell MM, Walsh J, Orero S. Kenya: reaching the poor through the private sector—a network model for expanding access to reproductive health services. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2005.Google Scholar
  29. 29.
    Gage A, Zomahoun D. Influence of the service delivery environment on family planning outcomes in Nigeria. USAID and MEASURE Evaluation; 2011.Google Scholar
  30. 30.
    MEASURE Evaluation PRH. Commodity security and logistics. (2011). Accessed December 2011.
  31. 31.
    Guilkey D, Speizer I, Lance P. Study design for the Measurement, Learning & Evaluation Project. Technical Working Paper: Measurement, Learning & Evaluation Project for the Urban Reproductive Health Initiative; 2009.Google Scholar
  32. 32.
    Measurement Learning & Evaluation Project, Nigerian Urban Reproductive Health Initiative, National Population Commission. 2010–2011 Baseline facility survey for the Nigerian urban reproductive health initiative. (2012). Accessed March 2012.
  33. 33.
    Consultative Group on International Agricultural Research. Poverty mapping: income poverty, vitamin A and iodine in Nigeria. (2006). Accessed January 2012.
  34. 34.
    City Population States and local government areas: the population of the states and local government areas of Nigeria. (2012). Accessed October 2012.
  35. 35.
    Hanson K, Kumaranayake L, Thomas I. Ends versus means: the role of markets in expanding access to contraceptives. Health Policy Plan. 2001; 16(2): 125–136.PubMedCrossRefGoogle Scholar
  36. 36.
    USAID | DELIVER PROJECT, Task Order 4. Nigeria: Contraceptive logistics management system assessment report. (2011). Accessed January 2012.
  37. 37.
    DELIVER and Task Order 1 of the USAID/Health Policy Initiative. Contraceptive security index 2006: a tool for priority setting and planning. Arlington: DELIVER, for the US Agency for International Development; December 2006.Google Scholar
  38. 38.
    Entwisle B, Hermalin A, Kamnuansilpa P, Chamratrithirong A. A multi-level model of family planning availability and contraceptive use in rural Thailand. Demography. 1984; 21(4): 559–574.PubMedCrossRefGoogle Scholar
  39. 39.
    Tsui AO, Hogan DP, Teachman JD, Chanes CW. Community availability of contraceptives and family limitation. Demography. 1981; 18(4): 615–625.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  • Jessica K. Levy
    • 1
    Email author
  • Sian Curtis
    • 1
  • Catherine Zimmer
    • 2
  • Ilene S. Speizer
    • 1
  1. 1.University of North Carolina Gillings School of Global Public HealthChapel HillUSA
  2. 2. University of North Carolina Howard W. Odum Institute and Department of SociologyChapel HillUSA

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