1) The document discusses an initiative to improve urban reproductive health in developing countries by integrating family planning services with other health services and increasing access through public-private partnerships. 2) An evaluation is being conducted in India, Kenya, Nigeria, and Senegal to measure the impact and document best practices, using surveys of women, men, households, and health facilities. 3) A key part of the evaluation is linking family planning users to the health facilities they use in order to analyze how facility quality, services offered, and distance relate to contraceptive use and choice of method.

1. New frontiers: Linking
family planning users to
health facilities

2. Why Focus on Urban
Reproductive Health?
 More than half of the world’s population lives in
urban areas
 Most population growth is occurring in towns and
cities in developing countries
– Urban populations of Africa, Asia and Latin America
will increase 1.9 Billion by 2030
 One in three urban residents live in slums
 Little attention devoted to urban reproductive
health

3. Data source: MLE Baseline Nigeria 2010

4. Background on the
Urban Reproductive Health Initiative
 Integrate family planning services with maternal and
newborn health services and HIV/AIDS services
 Improve quality of family planning services
 Increase family planning access through public-
private partnerships
 Create sustained demand for family planning
services among the urban poor
 Countries: India (UP), Kenya, Nigeria, Senegal
 Supported by Bill & Melinda Gates Foundation

5. Measurement, Learning & Evaluation
Project Objectives
1. To monitor and evaluate the impact of the Urban RH
Initiative within and across target countries using rigorous
study designs and multiple data collection approaches.
2. To build country and regional capacity to undertake
rigorous measurement and evaluation of population, family
planning, and integrated reproductive health activities with
a focus on urban and peri-urban poor and vulnerable
populations.
3. To facilitate knowledge sharing, document and
disseminate best practices across CC, in the region, and
within the global CoP.

6. MLE Partners
 Carolina Population Center (CPC) at the
University of North Carolina at Chapel Hill
 International Center for Research on Women
(ICRW) – Asia Regional Office
 African Population and Health Research Center
(APHRC)

7. Evaluation Design
 Large Longitudinal Sample
– To measure causal impact of the program
 Smaller Cross Sectional Survey
– To measure change in key indicators between baseline
and endline
– Men’s cross section at baseline, midline and endline
 Facility Surveys
– All facilities mentioned in the individual survey
– Random sample of additional facilities
– Census of high volume facilities
– Public and private facilities
– Longitudinal

8. Surveys to Date
 2010 Baseline surveys: Women, men, households, facilities
 2012 Midline surveys: Women, households
– Men’s surveys in Nigeria, Kenya
– Facility surveys in India
 India (Uttar Pradesh)
– Agra, Aligarh, Allahabad, Gorakhpur, Varanasi, Moradabad
 Kenya
– Nairobi, Mombassa, Kisumu, Machakos, Kakamega
 Nigeria
– Abuja, Ilorin, Ibadan, Kaduna, Benin City, Zaria
 Senegal
– Dakar, Mbour, Kaolak

9. Geographic Data Collection
 PSU/cluster latitude and longitude coordinates
– Longitudinal sample: new household locations
 Health facility locations
– Longitudinal sample
– New facilities added at midterm (India)

10. Use of Spatial Data for Sampling in India
 Slums were delineated by the Remote Sensing
Applications Center, India
– Polygon data, approximately 500-800 slum areas in
each city
 Slum areas were overlaid on QuickBird imagery
at CPC Spatial Analysis Unit
– Slum polygons were merged/divided to contain
approximately 100 households in each PSU
 Slum polygons were clipped out of city ward data
 Final sample for slums and non-slums was selected

11. Example of Slum Polygon Merging

12. Linking Family Planning Users
to Health Facilities
 Where did you obtain your current FP method?
 Where did you last go for ANC, CH, MH services
 Where did you last go for HIV testing (African
countries)
 What pharmacy do you usually go to for
medicine?
 Preferred providers
– The most popular provider in the cluster

13. Unique Datasets for Analysis
 Women’s preferences (the last place they went
for services)
 Facility surveys in the preferred facilities, and all
high volume facilities in the cities
– Facility audit, exit interviews
 Census of facilities in Senegal cities
– Facility audit, exit interviews
 Location and type of all facilities in Kenya,
Nigeria

14. India
 Preliminary results
– FP users were more likely to use modern
contraceptive methods if their preferred facility offered
integrated services and well-trained service providers
 Next steps
– Explore individual level preferred providers, quality,
and use

15. Nigeria
 Is quality of care associated with an increased
probability of current contraceptive use?
 Are women who identify high-quality facilities
more likely to use a long-acting permanent
method?
 Does distance vary according to quality of care
and/or type of method?

16. Innovations in Evaluation
 Urban women can chose from many facilities to
get their family planning counseling and
contraceptive methods
 Urban women may not even consider sources
close to their residence
 Choice of facility is intricately linked to the
choice of contraception
 Program evaluation methods that simply link
individuals to nearby facilities may include a
completely incorrect choice set

17. Conclusion
 MLE data provides new datasets which will allow
for the exploration of the influences of distance
and quality on choice of facilities, and use of FP
 Combining MLE data with existing health facility
datasets will add value to the MLE analysis

18. THANK YOU
The Measurement, Learning & Evaluation (MLE) Project for
the Urban Reproductive Health Initiative is funded by the Bill
& Melinda Gates Foundation. The MLE project is
implemented by the Carolina Population Center at the
University of North Carolina at Chapel Hill, in partnership with
African Population and Health Research Center, International
Center for Research on Women, and K4H.
The views expressed in this presentation do not necessarily
reflect those of the Gates Foundation.