Influence of the service delivery environment on family planning outcomes in Nigeria

While considerable effort and resources have been invested in improving family planning services, the influence of service quality on individual-level health outcomes is not well understood. The study's objective was to determine the association between family planning service quality in selected local government areas (LGAs) of Nigeria and contraceptive use, client satisfaction, and unplanned pregnancy rates among LGA residents. Data were derived from the 2009 household and health facility surveys for the Community Participation for Action in the Social Sectors project in Nigeria. In LGAs that offered more contraceptive choice (p<.001), had relatively more items to support quality family-planning counseling (p<.001), more management practices supportive of quality services (p<.001), and greater health-provider diversity (p<.01) residents had higher rates of modern contraceptive use than in other LGAs. Client satisfaction rates were higher in LGAs that were above the mean in terms of the scope of family planning in-service training received by providers (83% versus 69%) and health-provider diversity (92% versus 79%). Unplanned pregnancy rates were lower when the LGA offered greater contraceptive choice (33% versus 44%, p<.001) and had more items to support family planning counseling (34% versus 41%, p<.05), a facility that used a routine system for quality assurance (35% versus 47%, p<.001), and a facility that routinely provided family planning counseling in antenatal and postpartum care as well as treatment for sexually-transmitted infections (34% versus 45%, p <.01). The results of the study will provide insights into improving family planning program effectiveness.