Table 4 Implementation, client and policy constraints to achieving equity

1. Lack of quality comprehensive FP services, characterized by frequent stock outs, long distances to health facilities reflecting poor physical access of facilities, scope of services that does not meet the needs of marginalized populations including adolescents

2. Limited access to postpartum family planning (PPFP) for both home and facility deliveries

3. Lack of male involvement in supporting some women to take up FP

4. Weak inter-ministerial and partner coordination to provide FP to high burden and hard-to-reach populations including (refugees, young girls, islands and mountainous settings

5. The long-acting reversible contraception and permanent methods are not closer to clients

6. Ineffective supply and distribution chain of FP commodities

7. Lack of commodity and service delivery mapping to track the availability of commodities at the facility level

8. Inadequate number of skilled providers and poor attitudes which limits access to wide range of methods

9. Inadequate funding for equitable family planning

10. Generic FP programs without considering the needs of underserved populations

11. Uneven distribution of FP programs and partners

1. The socio-cultural factors-myths and misconceptions, religious values and gender inequality in rural communities

2. Limited contraceptive information targeting the young people, rural women and men

3. The high client out of pocket payments in the private sector and high cost of LARC hinder the rural poor from accessing FP services

1. The National and health sector development plan II and other FP policy documents have less focus on equity

2. There are no well-designed sector-specific policies and programs on gender to facilitate equitable access to SRH information and services

3. Inequities in FP use have received little national acknowledgement and attention from health policy-makers

4. Lack of multi-sectoral approach to implement the National Adolescent Health Policy Action Plan

5. Policies and plans are not effectively implemented to address

6. Limited understanding of FP national policies by the implementers