Iucd Utilization in Family Planning Client in Egpt

Abstruse

Understanding choice of family unit planning provider is fundamental for policy makers and plan managers equally they seek means to both better the coverage and increase the sustainability and efficiency of family planning services for Egypt to achieve its population objectives. This study focuses first on providing a descriptive profile of the patterns of reliance on sources of family unit planning services during the early on 2000s. Binomial logit models are and then estimated to obtain a more in depth understanding of the determinants of the choice of family planning providers in Egypt using the 2000 Arab republic of egypt Demographic and Health Survey. The report offers insights into a number of aspects of family planning service provision nigh which in that location has been less previous investigation. There are marked differences in the extent to which Egyptian women rely on public or individual providers for family planning services depending on the type of method they are seeking. Among the more than of import findings is the consistency women display in the choice of provider among women reporting multiple segments of use. With regard to the determinants of the choice of provider for family planning services, maybe the almost interesting finding is that household wealth was non a significant determinant of the choice of provider. This may reverberate that private sources met the need for family planning services of significant proportions of women in rural areas and among those in the depression income groups.

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Zaky, H. (2020) The Blueprint of Women's Reliance on Family Planning Providers in Arab republic of egypt. Advances in Reproductive Sciences, 8, 82-95. doi: 10.4236/arsci.2020.81008.

ane. Introduction

There is growing appreciation that women who obtain contraceptive services often have other reproductive health care needs, and that women obtaining other reproductive health care may have unmet contraceptive needs and that the needs of both of these groups of women can ofttimes be met best past providers who are able to offer a range of services. An inadequate supply of reproductive health preventive and curative services is idea to be an important cistron contributing to women'due south poor wellness status and loftier maternal bloodshed rates in developing countries.

Ideally, the availability of reproductive health services should not be a constraint to accessing reproductive health care. Beyond basic availability, other issues relating to supply go important including the factors that affect provider choice in cases where multiple outlets offering the same or similar services co-be. In looking at provider choice, a common dichotomy is between public and private providers. Where public and private sector outlets offer the same services, they generally differ in terms of toll, convenience, etc., leading the user to select an outlet on the basis of income, opportunity costs and personal preferences. In some instances, the public sector may distort the market past extending subsidies to clients willing and be able to pay higher prices for goods and services. Usually enquiry about providers mainly focuses on the supply side such as preparation of providers [1], cognition and practices [ii], nature of visit [3], provider characteristics [iv], the "culture" of service commitment [5], advice with clients [six], and integration of services [7]. On the other side, the demand in many instances is overlooked [8].

In Egypt during the early years of the 21^st century, contraceptive and other reproductive health care services were offered by virtually 5000 public wellness care unit, and more 20,000 individual-do obstetrician-gynecologists, and other sources (such as private clinics, hospital, mosques/churches, NGOs, etc.). Despite of this medical network, which is almost equivalent to that in some developed countries, Egypt contraceptive prevalence charge per unit reached only 56 per centum in 2000 with 54 per centum depending on modern methods and a full fertility rate of 3.5 live births/woman [9]. Unmet demand for contraception reached 11 pct while discontinuation charge per unit was as high as 30 percent within 12 months of starting use. Arab republic of egypt's population policy at that time was to achieve fertility replacement level past the year 2017. This required increasing prevalence, to almost 75 percent, decreasing discontinuation rate and unmet need, plus other reforms on other dimensions, such as the improvement of female teaching status, which were beyond the scope of this study. Existence at present in 2020, Egypt was not able to accomplish this fertility objective and fifty-fifty changed the whole population policy and its objectives.

This article attempts to obtain more than detailed insight into the factors that influenced the option of provider for family unit planning in Egypt during 2000. An understanding of the historical patterns of provider choice and their determinants will be of use to policy makers and program managers equally they seek ways in which to both meliorate the coverage and increment the sustainability and efficiency of family planning services for Egypt to achieve its population objectives. While the need for such investigation has been recognized, research relating to the option of family planning provider in Egypt is limited. Literature addressing aspects of the outcome within the Egyptian context includes few efforts [ten].

This article has two purposes: to describe historical patterns of reliance on public and private providers among family planning users; and to identify the determinants of the choice of public and individual providers in 2000.

2. Data

The data on the sources from which women obtained family planning services used in this article was fatigued from information collected in Egypt Demographic and Health Survey (EDHS) conducted in the yr 2000, which also included a detailed description of the sample. In the 2000 EDHS, family planning source information was nerveless for all episodes of contraceptive use during the five-yr menses before the survey. With regard to the current segment of utilize, data was obtained from all users on the source from which the method was obtained at the beginning of the electric current segment of use and, for users of methods requiring periodic resuppply (pills, injectables, condoms and vaginal methods), on the source to which user had gone most recently to obtain the method. For episodes other than the electric current segment, the source was the outlet at which the method was obtained at the kickoff of the segment. For purposes of the assay that followed, the family planning source was generally grouped by sector (public or private). In looking at the sources for methods requiring resupply (e.thou., the pill), the source was also looked at from the point of view of the type of provider (clinical and pharmacy/nonclinical).

2.1. Source at Outset of Current Segment of Utilise

Intrauterine contraceptive Device (IUD) was the most common method in Arab republic of egypt since it was being used by virtually 66 percent of current users. Pill was the 2d method (almost 18 percent). Table ane shows the distribution of current users of modern methods by blazon of source from which the method was obtained at the beginning of the current segment of use. Overall, at the time they began using their method, one in every ii of these users went to a public sector source for the method, one-third obtained the method from a individual clinic (including individual hospital/clinic/doctors, NGO/PVO clinics, and mosque/church clinics), and eleven pct went to pharmacies. The source from which users obtained services at the beginning of the current segment varied markedly by method. Table 1 shows that the bulk of IUD insertions occurred at a public sector source (54 percent) while 40 pct of the insertions were performed at individual clinics. Four out of five users obtained the injectable at a public sector source at the starting time of the current segment of employ, and almost all Norplant insertions took place at public facilities. The comparatively few respondents who reported use of female sterilization were evenly carve up between those obtaining the method at a public sector provider and those relying on a private provider.

At the commencement of the current segment, pill, safety and vaginal method users were more likely to report getting the method at a pharmacy (53 percent, 66 percent, and 46 percent respectively) than from either public or individual clinical provider. Effigy i compares the source at the get-go of the current segment with the source where the last supply of the method was obtained for current users of the pill and condoms. The results point that, as expected, many of the users who obtained these methods from a clinical provider switched to a chemist's shop for resuppply.

2.two. Differentials in Family unit Planning Sources past Background Characteristics

Table 2 and Table 3 present the distributions of current users past the type of source at the beginning of the segment according to selected demographic and

Table 1. Pct distribution of users of modernistic methods by type of source from which the method was obtained at the start of the current segment of use according to the method used, Arab republic of egypt DHS 2000.

IUD = intrauterine contraceptive device; NGO = non-governmental organisation; PVO = private voluntary organization; *Includes private infirmary/clinic/doctor and mosques/church building clinic; **Includes friends/relatives and other.

Effigy ane. Type of source at kickoff of electric current segment of utilize and at concluding resupply by method.

Table 2. Percentage distribution of users of the IUD past the type of source at the beginning of the segment according to selected background characteristics, Egypt DHS 2000.

socio-economical characteristics for the IUD and pill users—the two nigh popular methods in Egypt. The tables offer insights into how patterns of reliance on public and private sector providers varied among users of these methods. In the case of pill users, the results besides permitted an exploration of the question of how users who consulted a clinical provider when they began using the method differed from users who got the method from a chemist's shop without consulting a clinical provider.

For IUD users, the trend to go to public sector sources decreased and reliance on private clinics increased somewhat in importance as the respondent got older. For case, 59 percent of IUD users fifteen - 24 obtained the method from public sources compared to effectually l pct of those 40 - 49 years. In the case of the pill, in contrast, age was non strongly related to whether a user went to a clinical source or the pharmacy at the beginning of a segment of employ. In addition, among pill users who obtained the method from a clinical source, age differentials in the likelihood of going to a public or private outlet are non marked.

Urban-rural residence and place of residence were clearly related to the blazon of source from which women sought contraceptive services. Rural users were more probable to become the IUD from a public source than urban women. For instance, 59 percent of current IUD users in rural areas got the method from a public source compared to 49 percent of urban IUD users (Tabular array 2). Rural users were somewhat more likely than urban users to get the pill from pharmacies without consulting a clinical source. Moreover, urban users who got the pill from a clinical source were much more likely to obtain it at individual than at public outlets while rural pill users were more evenly divided between using public and private clinics (Table 3).

Looking at the differentials past identify of residence, reliance on public sources for the IUD was most common in rural Upper Arab republic of egypt, followed past rural Lower Egypt. Interestingly, in that location was somewhat greater variability in the level of reliance of IUD users on NGO/PVO providers by place of residence than existed for other characteristics. Pill users were least probable to get the method from a pharmacy at the beginning of the segment of use in urban Upper Egypt (46 pct) and most likely to get information technology there in rural Lower Egypt (57 percent). Amid urban pill users who did seek services from a clinical provider, private outlets were markedly more than popular than public outlets, whether the user lived in the Urban

Table 3. Percentage distribution of users of the pill past the type of source at the kickoff of the segment according to selected background characteristics, Egypt DHS 2000.

Governorates, urban Lower Egypt, or urban Upper Egypt. In dissimilarity, among rural pill users who obtained the method from a clinical provider, the division betwixt private and public outlets is more balanced.

A respondent'southward didactics and work status, her hubby's occupation and the household'due south position on the wealth alphabetize tended to markedly bear upon the choice of the source amongst IUD users. Users of these methods who were more than educated, working for cash, married to men in professional, technical or managerial occupations, and/or living in a household at the top of the wealth index were less inclined to obtain the method from public sources and more than inclined to rely on private clinics than other users.

Among pill users, these characteristics likewise were associated with the type of source, especially with the likelihood of consulting at a clinic rather than getting the method from a pharmacy. For example, among users at the bottom of the wealth index, 61 percentage got the method from pharmacies at the first of the current segment of use. In contrast, amongst users from households at the other end of the household wealth calibration, around 41 pct consulted a clinical provider at the get-go of the segment.

Regarding injectables which was the 3rd about mutual family planning method in Egypt (11 pct), the reliance on public providers was very articulate regardless of background characteristics of users. Withal, reliance on private providers increased with age, education, and wealth of users, and among urban residents (table not shown).

Finally, despite the close association betwixt the user's socio-economical level and the likelihood of reliance on a private clinical provider for contraceptive services, the findings also indicated that many users belonging to relatively wealthy households obtained services from public providers. For example, 40 percentage of the current IUD users living in households ranked at the top of the household wealth alphabetize obtained the method from a public provider.

2.three. Consistency in Choice of Sources

The 2000 EDHS collected data on the source from which a user obtained the method for all segments of apply of family planning methods during the five-year period before the survey. These information were used to answer questions nigh whether family planning users tended to remain "loyal" to a particular blazon of source in accessing services or whether they "switched" public and individual sources for services. Since injectables were for the nigh office simply obtained from public sources, the assay of patterns of consistency was express to IUD and pill users who reported ii or segments of use of the method during the five-year period before the survey.

Regarding consistency of blazon of provider among IUD users, Table 4 shows the percent distribution of women reporting multiple segments of IUD utilize during the five-year menses prior to the survey by type of source from which method was obtained during the segments of utilise according to the number of segments of use. The results clearly suggest in that location was a loftier degree of consistency in the type of provider. Iv in five of the women who reported multiple segments of IUD use relied on the aforementioned type of provider beyond all of the segments of apply. Forty-v percent were consequent in the choice of a public provider, 31 percent always went to private source, while 5 percent consistently got the IUD from a NGO/PVO clinic.

Table v indicates that, like IUD users, pill users tended to be consistent in

Tabular array iv. Percentage distribution of IUD users reporting multiple segments of use during the five-year flow prior to the survey by the type of source from which method was obtained during the segments of utilise according to the number of segments of use, Egypt DHS 2000.

IUD = intrauterine contraceptive device; NGO = non-governmental arrangement; PVO = individual voluntary organization; Note: Private includes private doctor/clinic and mosque/church clinic.

Table v. Percentage distribution of pill users reporting multiple segments of utilise during the five-yr period by consistency in the kind of provider (clinical versus chemist's/other) from which the pill was obtained according to the number of segments of apply, Egypt DHS 2000.

the choice of provider across multiple segments of utilise. Only around xx percentage of pill users switched between a clinical source and the chemist's shop. More half pill users consistently got their method from the pharmacy, and one woman in every four obtained information technology from clinical sources. Among those pill users who consulted clinical sources, this grouping of women also tended to be consequent in the choice of the type of clinical provider. 91 percent were consequent while only 9 pct used different types of providers. Amid consistent users, 80 percent always used private sources while eleven percent relied on public sources.

3. Issue of Women's Characteristics on Choice of Family unit Planning Providers

Studies of the demand for health care examined the effect of various provider characteristics on consumers' choice of provider for general medical intendance. In the family unit planning literature, estimation of the effects of quality characteristics of providers on choice of provider has been attempted [4]. The focus has always been the provider's characteristics. The users' or consumers' perspective is unremarkably treated equally a side issue. This article attempts here to further examine the determinants of the type of provider on which Egyptian women relied. The basic model used for exploring this question is a standard utility maximizing model which assumes that selection of provider is a function of the historic period of individual customer, her educational status, piece of work status, married man's occupation, number of living children, region of residence, household wealth, and type of method. The binomial logit model is used and the odds ratios are estimated.

Several model specifications are tested. Model 1 includes all users of the pill, IUD, and injectables who obtained their method from either a public sector provider or from a individual doctor/clinic; users getting the method from other types of sources are excluded from the analysis. Model 2 is express to users who likewise had a nativity in the five-year period before the survey. In add-on to the basic socio-demographic variables, a variable on the use of antenatal intendance services is introduced into this model. Model iii, which is limited to users who had a nativity and obtained antenatal intendance services, includes a variable on the type of provider from which the antenatal treat the concluding nascence was obtained.

The results of Model one indicate that the older the woman is the college her odds to choose private family planning providers. Older women (40 - 49) take double the odds to become to private sources compared to younger women (15 - 24). IUD and Injectables users had at to the lowest degree thirteen times the odds for choosing a public source than pill users accept. Increased education was associated with reliance on individual provider. Somewhat surprisingly, employed women were more probable to get to public providers. Probably this result was due to that employed women mainly work in the public sector which was linked to a public health care and health insurance systems. Women married to men working in managerial/technical/professional person jobs were more than likely to become their contraceptive methods from private providers than others. Rural Upper Egypt residents tended to get to public sector providers. Surprisingly, household wealth was non significantly associated with the type of provider from which the user obtained her method.

The add-on of use of antenatal care in the second model provides some boosted insight into the patterns of provider pick. Users who had given birth in the v-year period and received antenatal care were significantly more likely to have obtained a method from a private provider. It is worth noting that age was no longer important in determining type of provider which may be related to the fact that older users who had a recent kid were a select subset of all users in those historic period groups. Circumscribed the analysis to those who received antenatal care (Model three), the consistency of provider pick was clear; women going to public providers for antenatal care tended to go to public providers for their family planning method, almost 4 times the odd of going to a private provider.

The report considers two more than subsets of users, namely IUD and pill users. For IUD users, the results paralleled the findings for all users in Table half dozen. Older and more educated IUD users and those married to men in managerial/technical/ professional occupations were more probable to obtain the method from individual providers. Employed women were more likely to go to public providers. Rural Upper Arab republic of egypt users were more likely to rely on public sources. Wealth obviously had no bearing on women'due south pick of one type of provider over the other.

With respect to the pill, the tested model considered the determinants of the likelihood of getting the method from the pharmacy at the pharmacy versus a clinical provider. None of the variables were significantly related to blazon of provider with the exception of residence in rural Lower Egypt where users had lower odds to getting the pill from pharmacy. It was hypothesized that the lack of fit for other determinants might be due to the very high prevalence use of pharmacy since 84 percent of users obtain the pill at a pharmacy. All the same, when a model was run in which the group of pill users was limited to those who consulted a clinical source at the beginning of the segment of use, none the socioeconomic determinants of interest were related to the type of clinical provider (not shown in tabular array).

four. Final Remarks and Policy Implications

A number of conclusions tin can be drawn from this test of family planning providers in the early 2000s. First of all, the study confirmed the fact that there were marked differences in the extent to which Egyptian women relied on public or private providers for family unit planning services depending on the type of method they were seeking. This is perhaps nearly clearly illustrated in the well-known association betwixt the type of method used and the source from which women seek contraceptive services. Pharmacies supplied the vast majority of pill users, public facilities served the vast majority of injectable users while IUD users were more than equally divided between those seeking services from public

Table six. Odds ratios of binomial logit models for option of type of family planning provider.

Rc = reference category for the variable. ***p < 0.01; **0.01 < p < 0.05; *0.05 < p < 0.ten.

sector providers and those obtaining the method from individual providers.

The study offered insights into a number of other aspects of family planning service provision nigh which there had been less previous investigation. Amid the more than of import findings was the consistency women displayed in the option of provider. The majority of women reported multiple segments of utilise of the same family planning in the v-year flow before the survey reported obtaining the method from the same type of source at each segment of use.

With regard to the determinants of the selection of provider for family planning services, perhaps the most interesting finding was that household wealth was non a significant determinant of the selection of provider. This may reflect that private sources met the demand for family planning services of significant proportions of women in rural areas and among those in the depression income groups. Also, significant numbers among those in the high income groups were near paying nothing to get their methods. This finding had significant policy implications since it suggested that public subsidies were not reaching those in demand the most. More in-depth analysis was needed to identify causes of such distortions in the service commitment system and ways to correct information technology as well as using the most updated EDHS surveys to analyze trends and changes in consumer'due south behavior equally Egypt scales upwards its new wellness insurance system.

Conflicts of Involvement

The author declares no conflicts of involvement regarding the publication of this paper.

References

[1]	Speizer, I., et al. (2000) Practise Service Providers in Tanzania Unnecessarily Restrict Clients' Access to Contraceptive Methods? International Family Planning Perspectives, 26, 13-20 + 42. https://doi.org/10.2307/2648285
[2]	Stanback, J. and Twum-Baah, K. (2001) Why Do Family Planning Providers Restrict Access to Services? An Examination in Ghana. International Family Planning Perspectives, 27, 37-41. https://doi.org/10.2307/2673804
[3]	Landry, D. and Forrest, J. (1996) Private Physicians' Provision of Contraceptive Services. Family Planning Perspectives, 28, 203-209. https://doi.org/10.2307/2135839
[4]	Akin, J. and Rous, J. (1997) Effect of Provider Characteristics on Choice of Contraceptive Behavior: A Two-Equation Total-Information Maximum-Likelihood Estimation. Census, 34, 513-523. https://doi.org/ten.2307/3038306
[5]	Schuler, S., Bates, L. and Islam, M. (2001) The Persistence of a Service Delivery "Culture": Findings from a Qualitative Study in Bangladesh. International Family Planning Perspectives, 27, 194-200. https://doi.org/10.2307/2673855
[half-dozen]	Kim, Y., et al. (2000) Self-Assessment and Peer Review: Improving Indonesian Service Providers' Communication with Clients. International Family unit Planning Perspectives, 26, 4-12. https://doi.org/10.2307/2648283
[7]	Mayhew, Southward., et al. (2000) Implementing the Integration of Component Services for Reproductive Health. Studies in Family Planning, 31, 151-162. https://doi.org/10.1111/j.1728-4465.2000.00151.x
[8]	Frost, J. (2001) Public or Individual Providers? U.S. Women's Use of Reproductive Health Services. Family Planning Perspectives, 33, iv-12. https://doi.org/10.2307/2673736
[ix]	El-Zanaty, F. and Mode, A. (2001) Egypt Demographic and Wellness Survey 2000. Calverton, Maryland, USA; Ministry of Health and Population, Arab republic of egypt; National Population Council and ORC, Macro.
[10]	Heilman, E. and Martinkowsky, M. (1993) Trends in the Costs of the Family unit Planning Program in Egypt, Cairo, Egypt: National Population Council, Special Study Prepared under the OPTIONS Ii Projection, 1993.

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Source: https://www.scirp.org/journal/paperinformation.aspx?paperid=98483

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