1. Naira Kalra, M. Phil (Oxon), Doctoral Student Johns Hopkins Bloomberg School of Public Health (JHSPH) & Dr. Stella Babalola (JHSPH, CCP) 08_XXX_MM1 Relationship between provider interaction and type of contraceptive use in ever-married Nigerian women

2. Background Nigeria is the most populous country in Africa (>150 million) (NPCN 2006) High rates of unwanted, unplanned pregnancy. High rate of attempted abortions (1 in 7 women) 78.5% are due to non-contraceptive use (Lamina 2015) Contraceptive use in Nigeria is amongst the lowest in sub-Saharan Africa (contraceptive prevalence rate of 15%) and maternal mortality amongst the highest (Monjok et al., 2010) Contraceptive failure may be a reason for this. Pills, condoms and injectable account for 54% of contraceptive failure vs. 3.5% for implants and IUCD (Ipade Ola et al., 2013) LA/PMs are the most effective methods, are more cost-effective and require 1-2 provider interactions (Wickstrom and Jacobstein 2011)

4. Objective The study explores the relationship between provider interaction and type of contraceptive choice in ever-married Nigerian women Exposure of interest: woman’s experience of interaction with the provider measured using a GATHER score (greeting, asking, telling, helping, explaining and return) (Solter, C., 2000; Population Information Program CCP, 1998) Outcome of interest: woman’s choice of contraceptive techniques (long-term (LA/PM) or short term contraceptive techniques )

5. Methods Cross-sectional survey of 597 ever-married Nigerian women Data was collected in two family planning clinic sites in Ibadan and Kaduna (southern and northern part of the country). (conducted by NUHRI funded by the Gates Foundation) Included women who were either starting family planning for the first time or those that were restarting family planning after six months of discontinuation Multivariate logistic regression was carried out using the Huber-white robust (sandwich) variance estimator technique to adjust for clustering by provider

6. GATHER Index The GATHER score attempts to reflect each component of GATHER index equally In each sub index, the scores seem to be distributed in a skewed manner with more than 50% scoring a full on the ask, explain and return index

7. Results

8. Exploring the aspects of GATHER

9. Variable Odds Ratio Std. Error 95% Confidence Interval P- Value GATHER score1.270.101.09, 1.50<0.003 Religion Islam (ref Christianity)0.890.240.52, 1.520.67 Partners desire more children1.950.700.96, 3.950.07 Partner desires fewer children0.700.310.29, 1.670.421 Pregnancy in the next 6 months is a problem1.730.301.23, 2.44<0.002 Wait for >2 years for pregnancy/want children1.050.680.93, 1.190.441 Education1.120.170.83, 1.500.456 Past use of STM (ref no method)0.660.130.44,0.98<0.04 Past use of LTM (ref no method)3.352.870.62,18.000.159 Past use of traditional method (ref no method)0.930.490.33, 2.610.09 Past use of more than 1 (ref no method)3.052.780.51, 18.230.22 Age1.030.020.99, 1.070.95 Woman decides family planning method0.490.200.32, 0.75<0.001

10. Discussion We conclude that improved provider-client communication is associated with a preference for long-term contraception methods. Given that women are making a more permanent choice, increase in information and improved communication between provider and patient may be essential for women to feel comfortable with that choice.

11. References Ipade ola et al. (2013) Investigating claims of contraceptive failure among women of reproductive age in Nigeria: Findings from a national survey. Public Health Research. 3(5); 124-129. Lamina (2015) Prevalence of abortion and contraceptive practice among women seeking repeat induced abortions in western Nigeria. Journal of Pregnancy. Vol 1, pgs 1-7 Monjok et al. (2010) Contraceptive practices in Nigeria: literature review and recommendation for future policy decisions. Open access Journal of Contraception 2010: 1, pgs 9-22 National Population Commission of Nigeria (2006) Nigeria Population and Housing Census 2006.NPCN. Solter, C. (2000) Comprehensive Reproductive Health and Family planning Training Curriculum Module 3. Pathfinder International, Watertown, MA, USA. Population Information Program CCP, Johns Hopkins University (1998) Population Reports- GATHER Guide To Counseling. Family Planning Programs, Series J, Number 48. Wickstrom and Jacobstein (2011) Commentry Contraceptive Security: Incomplete without Long-acting and Permanent methods of Family Planning. Studies in Family Planning. Vol 42 (4) 291-297