Equity of Family Planning at Service Delivery Points in Uganda

Background Health is a basic and universal human right that was originally defined in the WHO Constitution (1946). Nevertheless, although health is shaped by social determinants such as age, living circumstances, employment, and various biological factors, access to some health services is not available to everyone, resulting in health inequities, particularly among certain subpopulations. In low-resource settings, health interventions such as family planning (FP) services have poor indicators for processes, outputs, outcomes, and impact due to access barriers that create inequities in 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. Methods Data were gathered from the UNFPA survey undertaken in 2023 in Uganda, involving 614 health facilities that provide FP services. Data was obtained from interviews with facility managers and FP clients' existing SDPs. The study included a total of 614 SDPs offering FP services, and 2,378 FP clients. We performed descriptive analyses to create frequencies and crosstabulations to identify differences in equity. Results On average, above 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 secondary level (98.3%), rural (91.3%), and government (93.1%) SDPs compared to their counterparts. In urban areas, a greater percentage of staff were trained to deliver modern contraceptive services (94.5%) or to perform IUD insertions and removals compared to those at rural SDPs. An average travel expense of approximately 4,884 Ugandan shillings was incurred to reach the SDP for FP services; those aged 10–19 years, particularly females and individuals with primary or no education, experienced longer waiting times to access FP services in comparison to others. Only half of the FP clients believed that service providers followed all the technical guidelines at the primary and secondary levels, whereas fewer than half of the clients at the tertiary level felt the same way. Conclusion There is a need to enhance community-based distribution through outreach programs, community health workers, drug shops, and pharmacies. These evidence-based practices can increase equitable access to high-quality FP methods for everyone in need.