Are Women in Lomé Getting Their Desired Methods of Contraception? Understanding Provider Bias from Restrictions to Choice

Elizabeth Pleasants, University of California, Berkeley
Tekou Bléwussi Koffi, Centre d'Evaluation et de Recherche Apliquée (CERA)
Karen Weidert, University of California, Berkeley
Ndola Prata, Bixby Center for Population Health and Sustainability, UC Berkeley

Provider bias is one way in which access to contraception can be restricted. This analysis assessed the prevalence of provider restrictions in contraception provision and the potential impact on women’s contraception method uptake in Lomé, Togo. The relationships between provider restrictiveness and women’s receipt of their desired method of contraception were modeled using mixed-effects logistic regressions looking at all women and among subgroups hypothesized to be at higher risk of bias. Around 84% of providers in this sample reported adhering to some type of restriction in contraceptive provision for the five contraceptive methods included in assessment (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Restrictions reported by providers did not appear to influence contraceptive method received for all women, but did influence use of LARC among unmarried women.