title: Bridging user and provider perspectives: family planning access and utilization in rural Mozambique.
abstract: OBJECTIVE
  To examine how the contraceptive behavior of women in rural southern Mozambique is shaped by their individual and household characteristics; community characteristics; access to family planning services; and characteristics of health facilities.
  
  
  METHODS
  Quantitative and qualitative data were collected mostly between January 20 and December 15, 2011, in rural areas of four districts in Gaza Province, Mozambique. The data included: a retrospective household-based survey of women of reproductive age (the analytical sample consisted of 1554 non-pregnant women in marital union); qualitative interviews with a subsample of surveyed women; a survey of communities where the women resided (n=56); and a survey of all health facilities in the study area (n=56). Binomial and multinomial logistic models were fitted to predict current use of modern contraceptive methods. Statistical analyses were complemented by insights from qualitative data.
  
  
  RESULTS
  Positive associations were detected between contraceptive use and education, household wealth, and perceived HIV infection status. Distance to the clinic was negatively associated with contraceptive use. These effects were additive, with some varying by type of contraceptive method. Examination of qualitative data highlighted frequent cognitive dissonance between service providers and users.
  
  
  CONCLUSIONS
  A simultaneous consideration of user-level and provider-level perspectives on contraceptive use improves our understanding of contraceptive dynamics and can usefully inform policy.
authors.affiliation: T. Denny Sanford School of Social and Family Dynamics, Center for Population Dynamics, Arizona State University, Tempe, USA. Electronic address: vag@asu.edu.
authors.forename: Victor
authors.initials: V
authors.lastname: Agadjanian
authors.affiliation: Department of Sociology and Institute for Population Research, Ohio State University, Columbus, USA.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Hayford
authors.affiliation: Cedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: Luz
authors.affiliation: Urban Big Data Centre, School of Social and Political Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Jing
authors.initials: J
authors.lastname: Yao
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D004522:Educational Status; D005191:Family Characteristics; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D017533:Marital Status; D008875:Middle Aged; D009073:Mozambique; D036301:Qualitative Research; D012111:Residence Characteristics; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Contraceptive methods; Family planning; Mixed methods; Mozambique; Provider-user interaction; Rural areas; Sub-Saharan Africa