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J Fam Plann Reprod Health Care: first published as 10.1136/jfprhc-2011-100244 on 20 August 2012. Downloaded from http://jfprhc.bmj.com/ on August 2, 2022 by guest. Protected by
Family planning providers’
perspectives on family planning
service delivery in Ibadan and
Kaduna, Nigeria: a qualitative study
Luciana Estelle Hebert,1 Hilary Megan Schwandt,2 Marc Boulay,3
Joanna Skinner4

1
Doctoral Student, Department ABSTRACT
of Population, Family and Objective In Nigeria, fertility continues to be Key message points
Reproductive Health, Johns
Hopkins Bloomberg School of high and contraceptive prevalence remains low.
Public Health, Baltimore, MD, This study was conducted in order to understand ▸ Some groups such as adolescents and unmarried
USA the perceptions of, experiences with and individuals are routinely excluded from family
2
Technical Advisor, Center for planning services.
challenges of delivering family planning services
Communication Programs, Johns ▸ Family planning providers need more marketing
Hopkins Bloomberg School of in two urban areas of Nigeria from the materials in order to promote family planning.
Public Health, Baltimore, MD, perspectives of family planning service providers. ▸ Family planning providers of all cadres need train-
USA Methods A qualitative study using 59 in-depth ing to empower them to be able to better
3
Assistant Professor and Senior respond to and counsel clients about different
interviews was conducted among family
Program Evaluation Officer, family planning methods.
Center for Communication planning providers working in hospitals, primary
Programs, Johns Hopkins health centres, clinics, pharmacies and patent
Bloomberg School of Public

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medicine vendors in Ibadan and Kaduna, Nigeria.
Health, Baltimore, MD, USA population level is generally acknowledged
Results Providers support a mix of individuals and
4
Monitoring and Evaluation as exhibiting a positive association.1 In
Advisor, Center for organisations involved in family planning provision,
Nigeria, where contraceptive prevalence
Communication Programs, Johns including the government of Nigeria. The Nigerian
Hopkins Bloomberg School of remains at a low 10% among married
government’s role can take a variety of forms,
Public Health, Baltimore, MD, women and 20% of women have an unmet
including providing promotional materials for
USA need for contraception,2 understanding the
family planning facilities as well as facilitating
roles and perspectives of family planning
Correspondence to training and educational opportunities for
Ms Luciana Estelle Hebert, providers is a critical step in designing
providers, since many providers lack basic training
Department of Population, effective interventions to both stimulate
Family and Reproductive Health, in family planning provision. Providers often
demand and increase usage of contracep-
Johns Hopkins Bloomberg describe their motivation to provide in terms of the
School of Public Health,
tive methods.
health benefits offered by family planning
Baltimore, MD 21205, USA; Family planning providers in Nigeria
methods. Few providers engage in any marketing
[email protected] span a wide range of facilities, professions
of their services and many providers exclude youth
and skill levels. The private sector encom-
Received 27 October 2011 and unmarried individuals from their services.
Revised 26 February 2012 passes all patent medicine vendors
Conclusions The family planning provider
Accepted 23 April 2012 (PMVs) and pharmacies, while all primary
community supports a diverse network of
Published Online First health centres (PHCs) are publicly funded
20 August 2012 providers, but needs further training and support in
by the government; hospitals and clinics
order to improve the quality of care and market
can be either public or private entities.
their services. Adolescents, unmarried individuals
PMVs, which comprise at least half of the
and women seeking post-abortion care are
family planning providers, are for-profit
vulnerable populations that providers need to be
entities that sell drugs but whose proprie-
better educated about and trained in how to serve.
tors are not required to be trained in drug
The perspectives of providers should be considered
dispensing.3 4 Pharmacies are usually
when designing family planning interventions in
staffed by a licensed pharmacist and func-
To cite: Hebert LE, urban areas of Nigeria.
tion primarily as a source for prescribing
Schwandt HM, Boulay M,
et al. Journal of Family
and dispensing drugs; clinics, hospitals
Planning and Reproductive INTRODUCTION and PHCs are staffed by trained medical
Health Care 2013, 39, The connection between family planning professionals and are responsible for
29–35. service quality and contraceptive use at the seeing and treating patients.3

Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244 29
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J Fam Plann Reprod Health Care: first published as 10.1136/jfprhc-2011-100244 on 20 August 2012. Downloaded from http://jfprhc.bmj.com/ on August 2, 2022 by guest. Protected by
The selection of methods offered varies by provider. goals in counselling and dealing with clients.
While PMVs are expected to stock contraceptives Evaluating the current marketing strategies of facilities
such as condoms,5 they are allowed only to re-supply, can help explain client flow and demand in providers’
but not initiate, oral contraceptive pills.6 They are also communities. Understanding the limits to care imposed
prohibited from providing injectable contraceptive by the providers themselves can illustrate why certain
and emergency contraception services, though some methods are less utilised than others and why certain
do so regardless.7 Hospitals tend to offer a greater groups continue to be underserved by the current
number of contraceptive methods, with a mean family planning care network.
number of 3.9 methods offered.3 Despite a more The Nigerian Urban Reproductive Health Initiative
limited selection of methods, 60% of Nigerian (NURHI) set out to understand the perceptions of and
women using a modern method receive their method experiences with family planning service provision in
at private facilities, such as PMVs and pharmacies.2 two urban areas of Nigeria from the perspectives of
The three most frequently used methods in Nigeria family planning service providers from all facility
are the male condom (4.7%), the injectable (2%) and types. The purpose of this exercise was to inform pro-
the pill (1.6%).2 While condoms and pills are the grammes designed to improve family planning services
most widely offered methods among all providers, the across urban Nigeria, since nearly half of the popula-
injectable is usually obtained only from hospitals and tion currently resides in urban areas.16 Using a sample
health centres. of facilities that was elicited by community members,
Previous research in Nigeria has mostly centred this study first explores how providers describe their
around specific cadres of family planning providers, perceptions of, experience with and challenges to deli-
for example PMVs or physicians serving in primary vering family planning in urban areas of Nigeria. It
care settings.6 8 9 A fair amount of this research has then reflects on how the perspective of providers can
focused on knowledge, attitudes and practice regard- be used to inform programmes aiming to improve
ing particular methods, specifically emergency contra- urban family planning provision.
ception and abortion.6 9–11 Less research has focused
on family planning provision itself. Given the promin- METHODS
ence of private sector providers, segregated inquiry Qualitative methods, specifically in-depth interviews
into provider perspectives by facility type leads to a using a structured guide, were used to collect these

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limited understanding of family planning service data. Interviewers also used an observation checklist
delivery in Nigeria. Moreover, since many providers in order to evaluate family planning marketing inside
offer some mix of methods (albeit less than the facility, outside the facility, on the facility walls, as
optimum), focusing on just one method illustrates well as the specific content and target audience for
only part of the picture regarding service provision. the promotional family planning materials.
Both within and outside Nigeria, provider perspec- A total of 59 in-depth interviews were conducted in
tives are known to impact family planning provision. September and October 2010 among male and female
Within Nigeria, providers’ views and concerns regarding family planning providers in facilities in Ibadan and
adolescent sexuality are associated with the contracep- Kaduna, Nigeria. In each urban area interviews were
tive services they are willing to provide to adolescents.12 conducted in a slum neighbourhood, a low-income
Situation analyses performed at clinically-based family neighbourhood and a middle-income neighbourhood.
planning service delivery points in Nigeria show that Communities that comprised each income level were
provider-imposed eligibility restrictions (based on age, selected through consultation with the Ministry of
parity or spousal consent) exist among many providers Health and academic demographers. Family planning
for specific methods.13 In Ghana, providers’ own per- providers were recruited based upon identification of
sonal beliefs or biases are reflected in the services they the facility as providing family planning during a cor-
provide or restrict to clients.14 In Uganda, providers responding community mapping exercise with male
face various barriers and challenges related to method and female community members. In order to encom-
availability and supply, providers’ own knowledge levels pass the varied types of facilities providing family
and financial accessibility, influencing the quality of care planning in Nigeria, the project sought to include a
they are able to provide.15 combination of up to 10 facilities located in each of
Incorporating research on providers is thus an inte- the six areas. While an array of types of facilities was
gral component in understanding the family planning desired, recruitment was contingent upon those iden-
context within a country. Recognition of how various tified in the mapping exercise. The final sample of
providers envision the role of the government can help providers is listed in Table 1.
clarify areas wherein the government can support the Ethical approval to conduct the study was obtained
existing provider network and opportunities to from the Institutional Review Board at the Johns
empower individual providers to improve their own Hopkins Bloomberg School of Public Health in
services. Consideration of why providers choose to Baltimore, MD, USA and the Obafemi Awolowo
deliver family planning can help describe providers’ University, Ile-Ife, Nigeria. Additional approvals were

30 Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244
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J Fam Plann Reprod Health Care: first published as 10.1136/jfprhc-2011-100244 on 20 August 2012. Downloaded from http://jfprhc.bmj.com/ on August 2, 2022 by guest. Protected by
Table 1 Characteristics of sampled family planning facilities by facility type, public or private status and
community income level in Ibadan and Kaduna, Nigeria
Family planning facility Private Public Slum Lower income Middle income Total
Clinic 10 1 4 3 4 11
Hospital 3 1 1 2 1 4
Primary health centre 0 8 2 3 3 8
Pharmacy 12 0 2 6 4 12
Patent medicine vendor 24 0 10 6 8 24
Total 49 10 19 20 20 59

obtained from the state Ministry of Health in the two The Nigerian government’s role in family planning
states where the study was conducted. Qualified and While providers expressed support for an integrated
experienced research assistants were recruited and network of providers involved in the delivery of family
trained by the research firm hired to collect the data. planning, they also voiced support for the government
The in-depth interview guides were pretested with playing a strong role in family planning services. Because
urban providers during the training and were refined the government has greater resources, some charged it
based on the pretest results. After study recruitment, with an instrumental role in the provision of family plan-
verbal informed consent was obtained from all study ning, through either direct or subsidised distribution of
participants before proceeding. methods. Others envisioned a broader role for the gov-
All interviews, with the consent of the participants, ernment, in either empowering community level provi-
were audio-taped and the recordings were transcribed ders or by educating the populace in order to stimulate
verbatim in the local languages. The transcribed demand and foster a more demand-driven environment
texts were then translated into English. Data sorting for family planning efforts.
and analysis were carried out using ATLAS.ti™ soft- “It [family planning] should be the responsibility of
ware and interview level matrices in Microsoft every one of us that is, the Government, concerned
Excel™. In addition to using the interview guide to people and non-governmental organisations.
develop the analysis codes, all transcripts were read Nonetheless, when it comes to education and enlight-

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to identify emerging themes and allow for the gener- enment on family planning services, I think the
ation of new codes based upon the providers’ own Government should take the lead.” [Female, PHC,
words. In this study ‘coding up’ as opposed to middle income, Kaduna]
‘coding down’ was utilised; meaning that the codes Providers also voiced support for government pro-
were developed based on the data and were not motion of family planning, expressing the need for
defined prior to data collection.17 The data analysis promotional materials in order to market both their
was guided by the thematic content analysis own specific services but also to promote family plan-
approach.18 ning in general. Providers saw this as an opportunity
for the government to create and distribute materials
RESULTS for these purposes. Finally, providers expressed how
Who should provide family planning government support of health facilities, through a
Providers named a wide variety of entities that they variety of forms including supply assurance and train-
believed should be charged with either the ability or ing, would better enable them to deliver family plan-
responsibility of delivering family planning to ning services.
Nigerians, with support for a combination of provi- “There should be governmental institutional support for
ders, spanning all facility types. private individuals that offer family planning. It could be
in terms of consistent supply of family planning methods
“I think everybody should be involved in providing
and funds for organising community-based programmes
family planning. Every shop should be actively
on family planning.” [Male, pharmacist in charge, phar-
involved – not only pharmacies and private medical
macy, middle income, Kaduna]
vendors. Family planning need is just as the need for
sanitary pad.” [Female, proprietor, pharmacy, slum,
Ibadan] Staff training and counselling
While some reserved provision of family planning In general, most providers had not received any train-
for “qualified” providers only, others described deliv- ing in family planning.
ery points needing to be “close to the people”. Some “None of our staff has received formal training on
also expressed support for community-level providers family planning services. Nevertheless, they all provide
for easy to administer methods, but reserved distribu- the services.” [Female, manager, pharmacy, middle
tion of other methods for skilled care settings. income, Ibadan]

Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244 31
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J Fam Plann Reprod Health Care: first published as 10.1136/jfprhc-2011-100244 on 20 August 2012. Downloaded from http://jfprhc.bmj.com/ on August 2, 2022 by guest. Protected by
Training on family planning was more common by offering them what they can use to achieve this.”
among those in hospitals, PHCs and clinics, although [Female, owner, PMV, slum, Kaduna]
there was often a mix of trained and untrained staff Nearly all providers planned to continue delivery of
members. As a safeguard to this, a system of internal family planning and many described a strong commit-
referral to more skilled or knowledgeable providers ment to their customers and to the goals of family
was sometimes used by providers, so that questions planning as reasons why they planned to continue. In
requiring more knowledge or administration of more fact, most providers said that they would like to
complex methods could be addressed properly. expand their family planning services, either in
Among pharmacists and PMVs, many saw no problem amount or range of methods offered; however, some
with staff having no training, describing condoms and reasoned that an increase in demand, both in general
pills as easy to administer and requiring only “on the and in terms of specific methods, would be needed in
job” training. order to expand family planning services.
“…they were not trained in providing family planning
services but because they sell the methods on a daily
Marketing of family planning services
basis I think that’s enough to give them experience to
counsel people.” [Male, manager, pharmacy, slum, While many providers understand the potential role
Ibadan] that promotion of family planning can play in expand-
ing contraceptive usage among their clients as well as
throughout the country, few actually engage in any
Motivation to provide family planning real promotional activities. Most providers shied away
Some providers explained they were motivated to from any external promotion of their services and
offer family planning because of the health benefits products, relying instead on in-house marketing, using
associated with family planning use. Providers framed posters or stickers to promote products inside the
these reasons primarily in terms of the health of the facility. Many providers also mentioned counselling
mother and the child. Some described how family clients on family planning as a way of letting clients
planning enabled women to space and limit their know they offer family planning, and relying on
births and some mentioned safe motherhood and word-of-mouth facilitated by this counselling.
reduction of mortality (especially due to unsafe abor-
tion) as opportunities made possible by family plan- “The people that patronise the facility tell each other

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ning. Providers at hospitals, PHCs and clinics cited about the family planning services offered here.…
There is no provision to inform the people who are not
health reasons as motivations to offer family planning
using the facility about the family planning services
more often than providers at PMVs and pharmacies. offered here.” [Male, director, private clinic, slum,
“The reason why we began to offer family planning in Ibadan]
this hospital was because health is wealth. Some
A substantial number of providers used in situ
women believe that since they are married their hus-
advertising of family planning methods, relying
bands have every right to demand sex at will. Most of
the time, the outcome is an unwanted pregnancy. We simply on the product alone to promote itself on the
encourage women to take their health as priority shelf.
during the childbearing period through effective appli- “Both users and non-users know that I offer family
cation of family planning mechanisms. We strongly planning services because it is openly displayed on the
believe that the use of family planning will minimise shelf.” [Male, owner, pharmacy, middle income,
some of the pregnancy-related complications.” Kaduna]
[Female, chief nursing officer, PHC, low income,
Ibadan] Whether this lack of formal marketing techniques
stemmed from lack of will or lack of materials was
A number of providers also explained that their
unclear, though few facilities had any external signage
decision to offer family planning was in response to
advertising family planning services.
the demand for the service from their clients. This
reason was more commonly mentioned among provi-
ders at pharmacies and PMVs than among other Excluded clients
health care providers. Even among those providers Providers often purposely excluded youth and unmar-
where initial demand motivated them to begin selling, ried individuals from their family planning services.
some also mentioned the collateral benefits offered While most did not provide justification for withhold-
with family planning, including those relating to ing family planning from these groups, concerns
health: about promiscuity were mentioned.
“What encouraged me initially was high demand [for “I don’t like attending to youth because of their
family planning] received from the people. But now I involvement in what they are not due for. Also, I don’t
think profit is not my major driver but how to improve like attending to the unmarried people.” [Female,
the reproductive health outcomes of every individual owner, PMV, slum, Ibadan]

32 Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244
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Some providers offered that youth should instead express the need for a variety of providers based on
seek services from “youth-friendly centres”. This the level of training or knowledge needed to adminis-
pattern of exclusion of youth and unmarried tended ter a method. Additionally, since a number of provi-
to be more common among pharmacies and PMVs ders already use an informal system of internal
than among clinics, hospitals and PHCs, but was still referral, this demonstrates that those providing family
unsettlingly prevalent across provider type. planning are cognisant of the limits of their skills, and
thus the limits of their services. Despite these safe-
Post-abortion care guards, however, the low prevalence of training in
Across facilities, many providers said they refer family planning methods, both within and outside
women seeking post-abortion care (PAC) to facilities skilled care settings, points to a clear area for improve-
equipped to help PAC patients, usually government ment. This lack of training in family planning has
hospitals or other “appropriate health centres”. When been seen in previous research among PMVs in
able, providers mentioned advising these women to Nigeria.6 Since the role of counselling is generally
use family planning to prevent unwanted pregnancies regarded as integral in contraceptive uptake and use,
from the offset. Some providers also mentioned the training providers in all spheres of skill should be
sensitive nature of providing PAC, since induced abor- prioritised.22–24
tion is illegal in Nigeria. At present, the federal government’s policy-
stipulated role in family planning delivery includes
“We don’t deal with post-abortion care because it procurement and distribution of methods, training of
could be implicating and you may be jailed if the health professionals and mass media communication
person dies in the process. We usually refer them to the
programmes, in collaboration with non-governmental
appropriate hospitals where they can be treated.”
[Male, manager, PMV, slum, Kaduna]
organisations (NGOs) and aid agencies such as the
United Nations Population Fund (UNFPA) and the
Alarmingly, a couple of primary health centres dis- Department for International Development (DFID).25
cussed treating only patients who had experienced However, these policy goals apply primarily to
spontaneous abortion, claiming to refuse care to those government-operated facilities, such as PHCs, and
among whom the abortion was induced. thus exclude the private sector. Given the needs of
“We do on few occasions especially when there are
providers, as well as their support for government

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complications due to natural pregnancy termination, involvement in family planning, these data provide
but not induced abortions. We don’t treat such cases evidence of the potential acceptability for a greater
here and we don’t abort.” [Female, nursing officer, role for the Nigerian Ministry of Health in supporting
PHC, low income, Ibadan] individual, including private, providers. Providers’
approval of the current mix of provision through
In addition, some providers described sending pharmacies, PMVs, clinics, PHCs and hospitals indi-
women seeking PAC back to the providers from cates that family planning services should continue to
whom they received the abortion, rather than to a be provided from a variety of service points; beyond
health facility equipped to handle the case. simply policy enactment that sets targets for increasing
“We treat those with post-abortion complications – contraceptive prevalence,26 it appears from these data
especially spontaneous abortion. If it is induced, we that instrumental government support through pro-
refer them to where the abortion was conducted.” motional materials, educational opportunities and
[Female, community health extension worker, PHC, training would be acceptable to providers at the com-
low income, Kaduna] munity level. In addition to greater government
involvement, connecting providers to NGOs and
DISCUSSION other family planning groups can further strengthen
The provider’s perspective in family planning delivery the ability of providers to deliver quality family plan-
represents an important component in effective provi- ning care. Working with providers to evaluate the
sion and usage of family planning.19 20 To date, no optimal modes of support might best serve Nigerians
known qualitative research has elicited the perspec- while also preserving the business and livelihoods of
tives of all variants of family planning providers in providers working in the private sector. Providers’ call
Nigeria in one study; thus, this study is the first to do for more government support is especially compelling
so. Though conducted in just Kaduna and Ibadan, the given the dominance of private facilities in the family
findings from this study can provide insight into how planning market in Nigeria.
family planning service delivery can be improved Since most providers interviewed were aware of the
throughout urban areas of Nigeria. health benefits that come with family planning, and
Providers support a diverse network of providers, many espoused these benefits as well as the desire to
reflecting the varying skill and care levels already pro- meet demand and serve their clients as reasons they
viding services to users throughout Nigeria.21 Of choose to provide, tapping into this duty-based reason-
note, however, is the insight that providers themselves ing could be an opportunity to educate and train

Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244 33
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providers. Furthermore, many providers do not have impact individuals. Focusing on these individuals first
the means or materials to promote their services in could lead to delivery of culturally sensitive promo-
their community, thus distribution of materials sup- tion of improvements in family planning, while also
porting and promoting family planning would likely be being responsive to the concerns that some providers
well received in the provider community. While expos- hold. Furthermore, identification of these leaders can
ure to mass media messages is positively associated better promote the development of a well-functioning
with contraceptive use,24 27 and there have been family family planning provider network, which Nigeria cur-
planning logo distribution campaigns in the past,3 pro- rently lacks.
viders in this sample lack the materials needed to The perspectives of family planning providers in
promote their own services. Thus, this area represents urban areas in Nigeria should be incorporated into
an opportunity for the Nigerian government and any strategies attempting to improve contraceptive ser-
NGOs to better equip providers to market and vices delivery and provide quality family planning
promote the family planning services they provide. care to Nigerians. These data indicate clear areas for
Providers in this sample also exhibited exclusionary improving the family planning landscape in urban
practices based on age or marital status, as has been areas of Nigeria and are already being used to inform
documented elsewhere in Nigeria and sub-Saharan NURHI family planning programme activities in the
Africa.12 14 Research using mystery clients has shown areas of demand generation, health systems strength-
that adolescents experience negative and judgmental ening, developing and supporting a family planning
attitudes and are sometimes counselled in religious provider network and advocacy. Through utilisation
matters rather than contraceptive methods when of the current network of family planning providers,
trying to access family planning services.28 Whereas offering greater educational and training opportunities
prior studies have indicated that youth prefer to use in family planning can address both lack of knowledge
PMVs for family planning because they perceive these and combat the personal biases of many providers. In
providers to be easy to access and confidential,29 the addition, the government and NGOs can play a more
present data indicate that providers’ own exclusionary active role in supporting family planning providers by
preferences may further prevent young and unmarried offering training opportunities as well as distributing
Nigerians from accessing reproductive and sexual materials to enable providers to market their services
health services. In these data, PMVs and pharmacists and promote family planning in general. Lastly, efforts

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tended to exclude young and unmarried clients more should be made to foster a more integrated and
often than did those working in clinics, hospitals and knowledgeable referral network for PAC services,
PHCs. Future efforts should, therefore, attempt to through network building and information-sharing.
increase providers’ knowledge of the consequences of Strengthening the provider community through these
these exclusionary practices. Interventions could pos- mechanisms has the potential to increase not only the
sibly explore incentive systems in order to motivate availability but also the quality of family planning
providers to include youth and unmarried in their ser- delivery in Nigeria.
vices, as has been found to be successful in other
contexts.30 Acknowledgements This study was made possible by the
Improvements also remain to be made in the realm generous support of the Bill and Melinda Gates
of PAC. While most providers reported referring Foundation. The contents are the responsibility of the
women seeking PAC to “appropriate” facilities, this Nigerian Urban Reproductive Health Initiative
was not universal nor was there any verification of (NURHI) and do not necessarily reflect the views of
whether those particular facilities were indeed capable the Bill and Melinda Gates Foundation. The research
of treating PAC clients. Efforts should be made to was made possible by the leadership and staff of the
increase transparency and publicity around facilities NURHI project: Dr Mojisola Odeku (Director), Bola
that offer PAC, especially within the provider commu- Kusemiju (Deputy Director) and the entire NURHI
nity. Previous research has shown inadequate aware- team. The authors wish to thank their research
ness of PAC services among providers; as those partner in Nigeria, Population Reproductive Health
findings are echoed in these data, it would serve Program (PRHP) of Gates Institute, Obafemi
Nigerian women well if the provider community were Awolowo University in Ile-Ife, and the family
informed of the appropriate facilities and procedures planning providers who consented to be interviewed
to make referrals for PAC.31 for this study.
Since some of these recommended improvements Funding Funding for this study was provided by the
would likely require a cultural shift in order to truly Bill and Melinda Gates Foundation.
be effective, a number of strategies could help bridge Competing interests None.
this cultural gap. Reaching out first to leaders in the
family planning service community to serve as change Provenance and peer review Not commissioned;
agents could channel resources and skills into high- externally peer reviewed.

34 Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244
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REFERENCES 17 Forrest Keenan K, van Teijlingen E, Pitchforth E. The analysis
1 Jain AK. Fertility reduction and the quality of family planning of qualitative research data in family planning and
services. Stud Fam Plann 1989;20:1–16. reproductive health care. J Fam Plann Reprod Health Care
2 Nigerian Demographic and Health Survey 2008 Final Report. 2005;31:40–43.
Abuja, Nigeria: National Population Commission, Federal 18 Green JA, Cyster JG. S1PR2 links germinal center confinement
Republic of Nigeria, and Calverton, MD: ICF Macro, 2009. and growth regulation. Immunol Rev 2012;247:36–51.
3 Gao J, Chapman S, Sun S, et al. The growth in newspaper 19 Paine K, Thorogood M, Wellings K. The impact of the quality
coverage of tobacco control in China, 2000–2010. BMC Public of family planning services on safe and effective contraceptive
Health 2012;12:160. use: a systematic literature review. Hum Fertil (Camb) 2000;3:
4 Oshiname FO, Brieger WR. Primary care training for patent 186–193.
medicine vendors in rural Nigeria. Soc Sci Med 20 Shelton JD. The provider perspective: human after all. Int Fam
1992;35:1477–1484. Plan Perspect 2001;27:152–161.
5 Ministry of Health, Federal Republic of Nigeria. Essential 21 Oye-Adeniran BA, Adewole IF, Umoh AV, et al. Sources of
Drugs List – Fourth Revision 2003. Abuja, Nigeria: Federal contraceptive commodities for users in Nigeria. PLoS Med
Ministry of Health, 2003. 2005;2:e306.
6 Fayemi MM, Oduola OL, Ogbuji QC, et al. The knowledge of 22 Gallen M, Lettenmaier C, Green C. Counseling Makes a
emergency contraception and dispensing practices of patent Difference. Population Reports, Series J, No. 35. Baltimore,
medicine vendors in South West Nigeria. J Public Health Policy MD: Population Information Program, The Johns Hopkins
2010;31:281–294. University, 1987.
7 Okonkwo AD, Okonkwo UP. Patent medicine vendors, 23 Rudy SJ, Polomano R, Murray WB, et al. Team management
community pharmacists and STI management in Abuja, training using crisis resource management results in perceived
Nigeria. Afr Health Sci 2010;10:253–265. benefits by healthcare workers. J Contin Educ Nurs
8 Brieger WR, Osamor PE, Salami KK, et al. Interactions 2007;38:219–226.
between patent medicine vendors and customers in urban and 24 RamaRao S, Mohanam R. The quality of family planning
rural Nigeria. Health Policy Plan 2004;19:177–182. programs: concepts, measurements, interventions, and effects.
9 Okonofua FE, Shittu SO, Oronsaye F, et al. Attitudes and Stud Fam Plann 2003;34:227–248.
practices of private medical providers towards family planning 25 Ministry of Health, Federal Republic of Nigeria. National
and abortion services in Nigeria. Acta Obstet Gynecol Scand Reproductive Health Policy and Strategy to Achieve Quality
2005;84:270–280. Reproductive and Sexual Health for All Nigerians. Abuja,
10 Onah HE, Ogbuokiri CM, Obi SN, et al. Knowledge, attitude Nigeria: Federal Ministry of Health, 2001.
and practice of private medical practitioners towards abortion 26 Federal Government of Nigeria. National Policy on Population

copyright.
and post abortion care in Enugu, South-eastern Nigeria. for Sustainable Development. Abuja, Nigeria: Federal
J Obstet Gynaecol 2009;29:415–418. Government of Nigeria, 2004.
11 Ebuehi OM, Ebuehi OA, Inem V. Health care providers’ 27 Bankole A, Rodríguez G, Westoff CF. Mass media messages
knowledge of, attitudes toward and provision of emergency and reproductive behaviour in Nigeria. J Biosoc Sci
contraceptives in Lagos, Nigeria. Int Fam Plan Perspect 1996;28:227–239.
2006;32:89–93. 28 Olowu F. Quality and costs of family planning as elicited by an
12 Adekunle AO, Arowojolu AO, Adedimeji AA, et al. Adolescent adolescent mystery client trial in Nigeria. Afr J Reprod Health
contraception: survey of attitudes and practice of health 1998;2:49–60.
professionals. Afr J Med Med Sci 2000;29:247–252. 29 Otoide VO, Oronsaye F, Okonofua FE. Why Nigerian
13 Askew I, Mensch B, Adewuyi A. Indicators for measuring the adolescents seek abortion rather than contraception: evidence
quality of family planning services in Nigeria. Stud Fam Plann from focus-group discussions. Int Fam Plan Perspect
1994;25:268–283. 2001;27:77–81.
14 Stanback J, Twum-Baah KA. Why do family planning providers 30 Meuwissen LE, Gorter AC, Kester AD, et al. Can a
restrict access to services? An examination in Ghana. Int Fam comprehensive voucher programme prompt changes in
Plan Perspect 2001;27:37–41. doctors’ knowledge, attitudes and practices related to
15 Mugisha JF, Reynolds H. Provider perspectives on barriers to sexual and reproductive health care for adolescents? A case
family planning quality in Uganda: a qualitative study. J Fam study from Latin America. Trop Med Int Health
Plann Reprod Health Care 2008;34:37–41. 2006;11:889–898.
16 United Nations. World Urbanization Prospects, the 2009 31 Adinma JI, Ikeako L, Adinma ED, et al. Awareness and practice
Revision: Highlights. New York, NY: United Nations, of post abortion care services among health care professionals
Department of Economic and Social Affairs, Population in southeastern Nigeria. Southeast Asian J Trop Med Public
Division, 2010. Health 2010;41:696–704.

Hebert LE, et al. Journal of Family Planning and Reproductive Health Care 2013;39:29–35. doi:10.1136/jfprhc-2011-100244 35