Where Do People in Nigeria Get Their Contraception?

1080 I n this issue of PLoS Medicine, Oye-Adeniran and colleagues report a new community study in Nigeria in which contraceptive users were surveyed about their sources of family planning information and contraception [1]. Enquiry about the source of contraceptive is a standard part of family planning surveys that assess knowledge, attitudes, and practices, and these surveys are commonly used in Nigeria and elsewhere [2,3]. The underlying proposition is that knowing where users obtain different contraceptive methods is useful for planning service delivery. The associated question—why do people choose a particular source for obtaining contraceptives (for example, a pharmacy rather than a clinic)—generally receives only passing attention. Over the years, there has been little variation in the pattern of contraceptive sourcing. Nonclinic facilities are the main source for obtaining condoms and the oral contraceptive pill, while the intrauterine contraceptive device and injectable contraceptives—both of which require health provider intervention—are predominately obtained from the clinic setting. Over time, neither the clinic nor the nonclinic sources have developed to their full potential as family planning providers, despite years of family planning programming in both public and private sectors. The New Study Oye-Adeniran and colleagues surveyed 2,001 persons aged 14–49 from four states of Nigeria—Anambra from the southeast, Oyo from the southwest, Kaduna from the northwest, and Bauchi from the northeast. These states were randomly selected for the study, one each from Nigeria's four health zones. A multistage cluster sampling design was used to select the respondents. Of the 2,001 people surveyed, 1,647 (82.3%) were sexually active, out of whom 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence rate of 14.8%. The study had three major fi ndings: (1) friends are the predominant source of information on contraception; (2) young people tend to prefer chemists (pharmacists), while older people prefer government and private hospitals as sources of contraception; and (3) Catholics prefer to avoid public health institutions. These fi ndings are similar to those obtained by Nigeria's 2003 Demographic and Health Survey [4]. There are several issues arising from this study. First, sources of contraception in the public sector are not set up to work with nonclinic sources, although a referral system may well suit the needs of clients. Second, the roles of the limited number of modern contraceptive methods available and of service providers in a sexually active person's choice of contraceptive …