Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity
Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity
Brooke W. Bullington,a,b Nathalie Sawadogo,c Katherine Tumlinson,b,d Ana Langer,e Abdramane Soura,c
Pascal Zabre,f Ali Sié,f Leigh Senderowicze,g
Introduction:Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways pro- viders restrict access to contraception. Here, we propose a dis-
tinction between the classical “downward” provider bias that discourages contraceptive use and a new conception of “up-ward” provider bias that occurs when providers pressure or en-courage clients to adopt contraception.
Methods: Using cross-sectional data from reproductive-aged women in Burkina Faso, we describe lifetime prevalence of
experiencing provider encouragement to use contraception due to provider perceptions of high parity (a type of upward pro-vider bias) and provider discouragement from using contra-ception due to provider perceptions of low parity (a type of downward provider bias). We also examine associations between sociodemographic characteristics and experiences of provider en- couragement to use contraception due to perceptions of high parity.
Results: Sixteen percent of participants reported that a provider had encouraged them to use contraception due to provider per-ceptions of high parity, and 1% of participants reported that a provider had discouraged them from using contraception because of provider perceptions of low parity. Being married, being from the rural site, having higher parity, and having attended the 45th-day postpartum check-up were associated with increased odds of being encouraged to use contraception due to provider perceptions of high parity.
Conclusion: We find that experiences of upward provider bias linked to provider perceptions of high parity were considerably more common in this setting than downward provider bias linked to perceptions of low parity. Research into the mechanisms through which upward provider bias operates and how it may be mitigated is imperative to promote contraceptive autonomy.