Provider Bias in Counselling Young Unmarried Women on Dmpa-Sc in Nigeria

Chioma Okoli, Akena Plus Health Trust
Aminat Tijani, Akena Plus Health
Ayobambo Jegede, Akenaplus Health - Innovations for choice and autonomy (ICAN) project
Ivan Idiodi, Akena Plus Health
Maddy Griffith, University of California San Francisco
Erica Sedlander, University of California, San Francisco
Elizabeth F. Omoluabi, Akena Plus Heath Trust
Jenny Liu, University of California, San Francisco

Depot medroxyprogesterone acetate-subcutaneous injection (DMPA-SC) was introduced in Nigeria in 2015, as a short acting, reversible contraceptive, that is self injectable, enhancing accessibility and control for women. Despite its benefits, some healthcare providers discourage its use among young unmarried women for fear it could delay return of fertility for future pregnancies. Provider counseling influences users’ perceptions and addressing these barriers, is crucial for adoption. Nigeria’s health guidelines require health providers to counsel and train first time users to self-inject before dispensing DMPA-SC units. During this training, first time users may encounter provider bias that could discourage its use in their contraceptive journey. Provider bias during counseling could deter women from adopting DMPA-SC. Effective contraceptive counseling is crucial for method uptake, continuation, and ensuring contraceptive agency. Our study involved 141 interviews with trained contraceptive counselors from both public and private sectors across three Nigerian states. Analysis revealed that provider bias affects the quality of counseling, particularly towards young unmarried women. This paper compares experiences between young unmarried women and multiparous women regarding DMPA-SC use, highlighting how provider bias manifests differently. Understanding and addressing this bias is vital for equitable, rights-based access to contraceptives and informed decision-making for women in Nigeria

Keywords: Family Planning and Contraception, Inequality, Disadvantage and Discrimination, Sexual and Reproductive Health and Rights, Fertility

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