title: Simulated clients reveal programmatic factors that may influence contraceptive use in Kisumu, Kenya.
abstract: A better understanding of the factors influencing use of family planning has the potential to increase contraceptive prevalence and improve the ability of women and their partners to freely choose the number and spacing of their children. Investigations into factors contributing to unmet need frequently rely on data collected using household surveys or interviews with family planning clients and providers. This research utilizes qualitative information resulting from simulated client visits to investigate programmatic barriers to contraceptive use in a sample of 19 health care facilities in Kisumu East District, a city in Western Kenya. Simulated client reports indicate deficiencies in provider competence as well as tenuous relations between providers and clients. In addition, simulated client data reveal occasional absences of providers during normal facility hours of operation and requests of informal fees for services. Trainings that address specific gaps in provider medical knowledge and counseling skills as well as client-provider relations may reduce programmatic barriers to contraceptive use. In addition, improved supervision and oversight at facilities may increase physical and financial access to services. Future research investigating provider motivations may illuminate root causes of programmatic barriers.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA ; Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tumlinson
authors.affiliation: Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA ; Department of Maternal & Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ilene
authors.initials: I
authors.lastname: Speizer
authors.affiliation: Tupange Project, Jhpiego, an affiliate of Johns Hopkins University, Nairobi, Kenya.
authors.forename: Linda
authors.initials: L
authors.lastname: Archer
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets