The public and private sector family planning supply environments and their influence on contraceptive use in urban Nigeria

Background: Over 50% of the world lives in an urban area. The highest rate of urban population growth is in Sub-Saharan Africa, where fertility rates remain high. To slow population growth and improve health and well-being, family planning (FP) advocates argue for increasing the use of modern FP through improved contraceptive access and availability. However, important questions remain about the best way to promote contraceptive use in countries with high fertility.;Purpose: The overarching aim of this dissertation was to explore the influence of the urban public and private FP supply environments on modern contraceptive use.;Methods: Data from the 2010--2011 Nigeria baseline survey conducted by the Measurement, Learning & Evaluation Project were used to create and assign aggregate level FP supply index scores to nineteen local government areas (LGAs) across six selected cities of Nigeria. It explored relationships between public and private sector FP services and determined whether contraceptive access and availability in either sector was correlated with community-level wealth. Path analysis was then used to estimate the direct effects of the supply environments on modern contraceptive use. Indirect effects were also analyzed using perception of supply as a mediating variable.;Results: Data showed pronounced variability in contraceptive access and availability across LGAs in both sectors, a positive correlation between public and private sector supply environments and localized associations between the supply environments and poverty. Furthermore, after controlling for influential covariates, analyses found that a woman's perception of supply had a significant positive effect on contraceptive use, whereas her actual immediate supply environment had negligible influence.;Conclusions: The distribution of contraceptive access and availability within an urban area is not a significant indicator of contraceptive use. Contraception must be available for women once (and if) they desire to use it. However, program planners and policy makers should be aware of FP market saturation. When existing demand is met, it may be most efficacious to concentrate on means of internal influence to promote FP, such as education, media and social networking, all of which help make contraceptive use an accepted, normative behavior.