title: Constraints and prospects for contraceptive service provision to young people in Uganda: providers' perspectives.
abstract: BACKGROUND
  Unintended pregnancies lead to unsafe abortions, which are a leading cause of preventable maternal mortality among young women in Uganda. There is a discrepancy between the desire to prevent pregnancy and actual contraceptive use. Health care providers' perspectives on factors influencing contraceptive use and service provision to young people aged 15-24 in two rural districts in Uganda were explored.
  
  
  METHODS
  Semi-structured questionnaires were used for face- to-face interviews with 102 providers of contraceptive service at public, private not-for-profit, and private for-profit health facilities in two rural districts in Uganda. Descriptive and inferential statistics were used in the analysis of data.
  
  
  RESULTS
  Providers identified service delivery, provider-focused, structural, and client-specific factors that influence contraceptive use among young people. Contraceptive use and provision to young people were constrained by sporadic contraceptive stocks, poor service organization, and the limited number of trained personnel, high costs, and unfriendly service. Most providers were not competent enough to provide long-acting methods. There were significant differences in providers' self-rated competence by facility type; private for-profit providers' competence was limited for most contraceptives. Providers had misconceptions about contraceptives, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements. Thus, most providers were not prepared or were hesitant to give young people contraceptives. Short-acting methods were, however, considered acceptable for young married women and those with children.
  
  
  CONCLUSIONS
  Provider, client, and health system factors restricted contraceptive provision and use for young people. Their contraceptive use prospects are dependent on provider behavior and health system improvements.
authors.affiliation: Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda. gnalwadda@gmail.com
authors.forename: Gorrette
authors.initials: G
authors.lastname: Nalwadda
authors.forename: Florence
authors.initials: F
authors.lastname: Mirembe
authors.forename: Nazarius M
authors.initials: NM
authors.lastname: Tumwesigye
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Faxelid
mesh_terms: D000028:Abortion, Induced / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000367:Age Factors; D003267:Contraception / Q000379:methods* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D018570:Risk Assessment; D016019:Survival Analysis; D014454:Uganda; D016387:Women's Health; D055815:Young Adult