Facility-level reproductive health interventions and contraceptive use in Uganda.

CONTEXT In Uganda, modern contraceptive use has recently increased in areas served by the Delivery of Improved Services for Health (DISH) project. Whether these increases are associated with facility-level factors is unknown, however. METHODS Data from the 1999 DISH Evaluation Surveys were used in multivariate logistic regressions to assess the independent relationships of five indicators of the family planning service environment with individual-level use of a modern contraceptive in rural and urban areas. The surveys consisted of a household questionnaire of 1,766 women of reproductive age and a facility module implemented in all health facilities that serve the sampled population. RESULTS After women's social and demographic characteristics were controlled for, none of the service environment factors was independently associated with current use of a modern method in rural areas. By contrast, in urban areas, the proximity of a private health facility (which likely reflects an increased availability of methods) was positively associated with current use (odds ratio, 2.1), as was the presence of a higher number (three or more) of DISH-trained service providers (1.7). CONCLUSIONS The presence of private health facilities was the factor most strongly associated with contraceptive use in urban areas, perhaps because they improved the availability of methods. Few other facility-level program inputs had significant effects.