Equity of family planning at service delivery points in Uganda

In low-resource settings, family planning (FP) services have poor outcome indicators due to inequitable policies and processes that create access and uptake barriers. While recent measurement initiatives have primarily concentrated on employing metrics of FP use, it is therefore essential to measure process indicators that are remediable and directly influence access to and uptake of FP services. Using the Availability, Accessibility, Acceptability and Quality process indicators based on the United Nations Population Fund (UNFPA) survey 2023, we assess equity in FP services at service delivery points (SDPs) in Uganda. This was a secondary analysis of data from a descriptive cross-sectional UNFPA 2023 survey in Uganda, which used face-to-face survey interviews and client exit interviews. The survey involved 614 health facilities that provide FP services and 2,378 FP clients. Data were obtained from interviews with facility managers and FP clients exiting SDPs. Data were collected in 2023, from September 13 to October 3, and for this research paper, data access occurred on December 17, 2024, and analysis was performed using STATA version 15. Descriptive analyses were conducted to generate frequencies, percentages and means by service delivery point (SPD) and clients’ characteristics to identify differences in the outcome across the various health facilities and clients’ sub-groups. On average, over three-quarters (89.7%) of all surveyed SDPs consistently provided a minimum of three modern contraceptive methods as part of their regular services. The highest proportion of SDPs that regularly offered at least three modern contraceptive methods was reported by Health Centre (HC) IV level facilities (98.3%), rural (91.3%), and government (93.1%) SDPs compared to their counterparts. FP clients aged 15–19 years spent an average of 72 min waiting for FP services, compared to clients aged 20–29 years and 30–39 years, who spent an average of 66 min and 69 min, respectively. Female FP clients waited an average of 66 min for FP services, while male clients waited an average of 43 min. FP clients with no education or primary education experienced longer waiting times. Specifically, they waited an average of 68.4 min and 69.5 min, respectively. In contrast, clients with post-primary education waited an average of 55.8 min. Only 53.3% of FP clients (675 out of 1267) believed that service providers adhered to all best practices in FP service delivery across all levels of service delivery points. There is a need to enhance community-based distribution through outreach programs, community health workers, drug shops, and pharmacies to improve access and uptake of FP services for underprivileged groups like adolescents and women in rural areas, while empowering and equipping lower-level service SDPs by skilling personnel, making commodities and supplies available and improving service delivery processes to effectively provide FP methods. These evidence-based practices can increase equitable access to high-quality FP methods for everyone in need.