Context: Medical barriers can limit the use of family planning services, even in situations where family planning services are physically accessible and economic barriers are few. This study investigates the presence of four types of medical barriers among providers at government family planning service delivery points in Tanzania: overspecialization, eligibility restrictions, process hurdles, and provider bias.
Methods: Data from the 1996 Tanzania Service Availability Survey are used in the study. Barriers are analyzed by type of provider, type of facility, and urban/rural location. Estimates of the proportion of facilities that are "barrier-free" are also made.
Results: A relatively high proportion of provider’s restrict eligibility by age, particularly for oral contraceptives, the most widely used method by Tanzanian women. Restrictions were also observed according to a woman’s marital status, parity, and spousal consent. Medical aides, trained midwives, MCH aides, and auxiliary staff, the most common type of family planning service provider in rural areas, were the most likely to impose age restrictions (79 to 81 percent) for the pill. Ten to 13 percent of providers reported that there was at least one modern method that they would never recommend, and 40 percent reported inappropriate process hurdles in the provision of hormonal methods. In the aggregate, these restrictions and hurdles severely limit access to contraceptives for certain groups of women. Young, unmarried, non-menstruating women, for example, would encounter one or more barriers or process hurdles at more than 70 percent of urban and 80 percent of rural facilities. Conclusions: Although the Tanzanian National Family Planning Program has made considerable progress in improving access to family planning services in the 1990s, further efforts are needed to reduce and ultimately eliminate unnecessary provider restrictions to contraceptive use. Compliance with the National Family Planning Program’s service guidelines and standards would seem to be in need of greater emphasis in pre- and in-service training and during supervisory visits.