Skip to main content

Table 2 Summary of evidence on impact of FP interventions/ service delivery models for urban slums

From: Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact

Country Author FP intervention Outcomes measured Impact of family planning service delivery model
Bangladesh Huda et al.
2019 [21]
Married Adolescent Girls Club Effectiveness of a married adolescent girls club in reducing unmet need for family planning • The percentages of the targeted population using any modern method of contraception were significantly higher among respondents in the intervention areas than those in the control areas (72.6 % versus 63.5 %).
• The unmet need for FP was significantly lower among respondents in the intervention areas than that of the control areas (16.2 % versus 20.7 %).
• The MAG club was a well-received strategy to provide comprehensive information on FP, which in turn helped improve contraceptive method practices and reduced the unmet need for FP among married adolescent girls in urban slums in Bangladesh
Pakistan Hennink and Clements, 2005 [20] Franchised family planning clinics Knowledge, contraceptive use and unmet needs for family planning services • The clinics contributed to a 5 % increase in overall knowledge of family planning methods and an increase in knowledge of female sterilization and IUD of 15 and 7 % respectively.
• Distinct effects were found on contraceptive uptake, including an 8 % increase in female sterilization and a 7 % decline in condom use.
• Unmet need for family planning declined in two sites, whereas impacts on the other sites were variable.
• Although the new clinics are located within poor urban communities, users of the services were not the urban poor, but rather were select sub-groups of the local population.
Senegal Benson et al. 2018 [28] Urban Health Initiative Impact of demand and supply-side activities on modern contraceptive use • By endline there was increased exposure to radio and television programming, religious leaders speaking favourably about contraception, and community-based initiatives.
• In the same period, modern contraceptive use increased from 16.9–22.1 % with a slightly larger increase among the poor (16.6–24.1 %)
• Multivariate analysis demonstrate that women exposed to community-based activities were more likely to use modern contraception by end line (marginal effect (ME): 5.12; 95 % confidence interval (CI): 2.50–7.74) than those not exposed.
• Further, women living within 1 km of a facility with family planning guidelines were more likely to use (ME: 3.54; 95 % CI: 1.88–5.20) than women without a nearby facility with guidelines.
• Among poor women, community-based activities, radio exposure (ME:4.21; 95 % CI: 0.49–7.93) and living close to program facilities (ME: 4.32; 95 % ci: 0.04–8.59) impacted use.
India Achyut et al., 2016 [27] Urban Health Initiative Impact of demand and supply side factors influencing access to and provision of FP • Impact evaluation results show significant effects of exposure to both demand and supply side program activities.
• In particular, women exposed to brochures (marginal effect: 6.96, pb.001), billboards/posters/wall hangings (marginal effect: 2.09, pb.05), and FP on the television (marginal effect: 2.46, pb.001) were significantly more likely to be using a modern method at end line.
• In addition, borderline significance for being exposed to a community health worker (marginal effect: 1.66, pb.10) and living close to an improved public and private supply environment where UHI undertook activities
Nicaragua Meuwissen et al. 2006 [25] Voucher scheme Knowledge of contraceptives,
contraceptive use
method of preference
factors that influence use of contraceptives
• The mean number of problems presented was 1.5 per consultation: 34 % of the vouchers were used for contraceptives, 31 % for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28 % for advice/counselling, 28 % for antenatal check-up and 18 % for pregnancy testing.
• A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment.
• Contraceptive use doubled among the sexually active non-pregnant voucher redeemers.
• Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed
Uganda & Kenya Arur et al., 2009 [26] Voucher scheme Use, responsiveness, and quality of FP • In Kenya, uptake of RH-OBA SM vouchers has been high. Between June 2006 and October 2008, 78,651 SM vouchers were sold and 60,581 women used SM vouchers to deliver in a participating facility.
• In contrast, use of FP vouchers was considerably lower than expected. In the same period, only 25,620 FP vouchers were sold, and 11,296 (41 %) of these were used.
• Examination of provider claims data reveals that FP voucher users overwhelmingly prefer implants to other long-acting and permanent methods. Almost two-thirds (60 %) of FP voucher users selected implants, compared to a third (35 %) who chose female sterilization (bilateral tubal ligation, or BTL). Only 5 % opted for intrauterine contraceptive devices (IUCDs).
• Voucher utilization patterns indicate that the poor in Kenya prefer to use private for-profit and non-profit providers. In the area of FP, non-profit providers were the preferred provider (59 %) across all voucher site locations.
• Private non-profit providers appear to be a particularly important source of surgical methods of contraception: private non-profit providers submitted 90 % of all claims for BTLs. Non-profit providers were also the preferred provider for SM services and accounted for 45 % of SM claims.
• Between February 2009 and June 2009, 4,034 RHVP SM vouchers were sold and close to 2,451 (61 %) used for ANC, institutional deliveries, or PNC services.
• Uptake in the first few months of RHVP may have been low as voucher systems take a long time to set up, particularly on the large scale of the RHVP. However, the gap (61 %) between the number of vouchers sold and used is now closing.
Nigeria Krenn et al. 2014 [22] Nigerian Urban Reproductive Health Initiative Awareness and utilisation of FP services • Between baseline and midterm, the percentage of women who believed in myths or had misconceptions about contraception declined between 9 and 17 % points on outcomes measured
• Intention to use contraception in the next 12 months increased between 7.5 and 10.2 % points in four cities
• Actual contraception use increased between 2.3 % points (in Abuja) and 15.5 % point (in Kaduna) from baseline to midterm
• Reported exposure to several of the Nigerian Urban Reproductive Health Initiative (NURHI) communication interventions was significantly associated with higher levels of contraceptive use.
• Propensity score matching found a 9.9 % point increase in contraceptive use in the 4 cities attributable to project exposure
Ghana Henry et al., 2020 [24] The Willows home-based counselling and referral programme Women reported contraceptive use • 10.5 % point increase in use of modern contraceptives from baseline to close (95 %CI : 6.2, 14.8; P < 0.001) and a 7.6 % point increase from baseline to end of project (95 %CI : 3.3, 11.9; P < 0.001).
• Only 20.2 % of women in the Willows intervention area reported a visit. The intervention, therefore, did not achieve its aim to reach all reproductive-aged women in the community.
• The programme had a significant impact on modern contraceptive use at the close of the programme among women who received an information or counselling visit
Bangladesh Uddin et al., 2012 [23] Clinics near the place of residence (static clinic and satellite clinics) Use of family-planning methods among street-dwellers • The use of healthcare services by the street-dwellers increased at endline compared to baseline in both the model clinic areas, and the difference was highly significant (p < 0.001).
• Institutional delivery among the female street- dwellers increased at endline compared to baseline in both the clinic areas.
• The use of family-planning methods among females also significantly (p < 0.001) increased at endline compared to baseline in both the areas.