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Provider resistance to advance provision of oral contraceptives in Africa
  1. John Stanback, PhD, Senior Associate and
  2. Barbara Janowitz, PhD, Director, Health Services Research
  1. Family Health International, Research Triangle Park, NC, USA
  1. Correspondence John Stanback, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. Tel: +1 919 405 1473. Fax: +1 919 544 7261. E-mail: jstanback{at}


Context In Africa, many new family planning clients are not menstruating at the time they present for services. Where pregnancy tests are unavailable, clients are often denied their method of choice and sent home to await menses. For pill clients, one obvious solution is 'advance provision' of oral contraceptives for later use. However, this practice is rare in Africa.

Objective To assess the level of provider resistance to advance provision of oral contraceptives.

Design We added questions about advance provision of pills to five provider surveys in three African countries. We also used simulated clients in Ghana to assess provider resistance to the practice.

Results In Kenya, only 16% of providers thought it safe to give women oral contraceptives to be started at a later date. In Ghana and Senegal, fewer than 5% of providers mentioned advance provision as a way to manage nonmenstruating pill clients.

Conclusion Training programmes and service delivery guidelines in developing countries should provide for advance provision of pills to appropriate clients

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