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

Abstract

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.

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Notes

  1. 1.

    Nigeria is subdivided into states, which are further subdivided into LGAs. This study looks at the urban portions of the LGAs that lie within six cities of Nigeria. Please see the “Research Design and Methods” section for more details.

  2. 2.

    The MLE project was funded by the Bill & Melinda Gates Foundation to conduct a rigorous impact evaluation of their Urban Reproductive Health Initiative (URHI). The URHI aims to promote innovative FP programs in urban areas of four countries: Uttar Pradesh, India; Nigeria; Kenya; and Senegal. The goal of the MLE is to identify the most effective and cost-efficient programmatic approaches to increase access to, demand for, and use of high-quality FP among the urban poor in each of the URHI intervention sites.

  3. 3.

    The agencies included the National Bureau of Statistics, Federal Ministry of Health (MoH), National Primary Health Care Development Agency, State MoH offices, Guild of Medical Directors, Association of General Private Medical Practitioners, Association of Private Nurse Practitioners, Association of Community Pharmacists, Association of Proprietary and Patent Medicine Dealers, and a list of registered pharmacies.

  4. 4.

    In Ibadan, due to the large number of facilities, only the health facility most commonly mentioned by women in the same cluster was considered to be the preferred facility.32

  5. 5.

    This measure is being used to reflect the availability of a marker method. According to representative data collected by MLE in 2010, the most commonly used or ever-used modern contraceptive methods among women in union, living in urban areas of Nigeria is the male condom or injectable.2

  6. 6.

    It is more difficult to obtain an IUD in Nigeria than other reversible modern methods, and yet, it is one of the more effective contraceptive choices for preventing pregnancy.2 Therefore, this measure is being used as a high-level marker of method choice. Note that pharmacies and PMSs do not sell the IUD, so it is only included for public and private health facilities.

  7. 7.

    MLE calculated household wealth scores using principal component analysis and assigned those scores to the respective household members. They then ranked the individuals living in the same city from poorest to least poor and divided the resulting data into quintiles.

  8. 8.

    These correlations were not quite statistically significance at the 5 % level.

  9. 9.

    Reminder: The sample was designed to produce estimates with acceptable precision at the city level not the LGA level; therefore, there will be potentially large sampling error at the LGA level.

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Acknowledgments

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.

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Correspondence to Jessica K. Levy.

Appendix

Appendix

Table 8 Steps for creating LGA-level variables that were used to measure FP supply environment “strength” for each SDP type

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Levy, J.K., Curtis, S., Zimmer, C. et al. Assessing Gaps and Poverty-Related Inequalities in the Public and Private Sector Family Planning Supply Environment of Urban Nigeria. J Urban Health 91, 186–210 (2014). https://doi.org/10.1007/s11524-013-9841-8

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Keywords

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