Facility-level reproductive health interventions and contraceptive use in Uganda.

CONTEXT: In Uganda, modern contraceptive use has recently increased in areas served by the Delivery of Improved Services for Health (DISH) project. Whether these increases are associated with facility-level factors is unknown, however.

METHODS: Data from the 1999 DISH Evaluation Surveys were used in multivariate logistic regressions to assess the independent relationships of five indicators of the family planning service environment with individual-level use of a modern contraceptive in rural and urban areas. The surveys consisted of a household questionnaire of 1,766 women of reproductive age and a facility module implemented in all health facilities that serve the sampled population.

RESULTS: After women's social and demographic characteristics were controlled for, none of the service environment factors was independently associated with current use of a modern method in rural areas. By contrast, in urban areas, the proximity of a private health facility (which likely reflects an increased availability of methods) was positively associated with current use (odds ratio, 2.1), as was the presence of a higher number (three or more) of DISH-trained service providers (1.7).

CONCLUSIONS: The presence of private health facilities was the factor most strongly associated with contraceptive use in urban areas, perhaps because they improved the availability of methods. Few other facility-level program inputs had significant effects.