Delivery and utilisation of injectable contraceptives services in rural Nigeria: learning from the perspectives of patent medicine vendors and women of reproductive age

Abstract

Patent medicine vendors (PMVs) are major providers of reproductive health services in Nigeria. Although several studies have explored the role of PMVs in the provisioning of contraceptive services in general, few have specifically assessed their contribution to the delivering injectable contraceptives. Little information is also available on the experiences of Nigerian women who use injectable contraceptives provided by PMV in rural medically underserved communities. A descriptive cross-sectional survey was conducted in four rural Local Government Areas (LGAs) in Oyo state, Nigeria. Trained interviewers conducted face-to-face interviews among all the 396 PMVs identified using the snow-balling approach. The PMV were interviewed using a 52-item validated questionnaire that elicited information on their demographics, knowledge and delivery of injectable contraceptives. Face-to-face interviews, using a 35-item questionnaire were also conducted among 393 previous or current users of injectable contraceptives who were randomly selected from their households. Information collected from the women included personal characteristics, use of injectable contraceptives, and sources of supply. Majority of the PMVs were females (84.8%) and 29.3% had previously worked in a health facility. Almost all (94.6%) the PMVs were shop owners. Majority (89.1%) of the PMV were aware of injectable contraceptives and 39.0% had ever received any training on the provision of family planning services. Yet almost all (95.9%) reported providing at least some type of contraceptive services. About 13% of the PMVs had sold injectables. Besides selling injectable contraceptives, 14.9% of the PMVs reported administering injectables and 43.9% reported referring clients to a formal health facility for this contraceptive. Slightly over half (51.9%) of the women were in the 30-39 year age group. Depo-Provera was the most popular injectable used, accounting for 82.3% of previous use and 77.6% of current use. Among previous users, 68.9% had received services from a health facility, 19.6% from a PMV, and 11.5% from a community health worker. Current users obtained their services from PMVs (22.6%), health facilities (66.0%), and community health workers (11.4%). Although pharmacy laws in Nigeria do not permit PMVs to offer injectable contraceptives, PMVs reported sale and administration of injectable contraceptives in response to demand from clients. Interventions and policy actions are needed to ensure that PMVs are a safe contact for clients with family planning needs.

Keywords: Patent medicine vendors, injectable contraceptives, delivery of reproductive health services, Nigeria