The study aimed to determine the prevalence of modern contraceptive use, describe methods used as well as factors associated with use among women aged 16–44 years in two districts in Arusha region. The results of the study showed that 47% of women in Arusha region were using modern contraceptive methods, without significant difference between Arusha City and Meru DC districts. These districts have reached the national goal of FP coverage of 45% by 2020 (22).
Wide availability of methods at health facilities in Arusha, offering services five days a week, the introduction of immediate postpartum long term FP program and wide community information and education of family planning and adequate spacing that was undertaken from 2015 might have all contributed to the high contraceptive use [10, 25, 26]. In Northern zone (Arusha one of the regions) there was intensive training of health providers in long term methods in 2016–2017. The training coupled with introduction of immediate postpartum long-term family planning (LTFP) program in Tanzania since 2015 might have influenced improvement in modern contraceptive use in Arusha (29). Efforts and strategies are still needed though, to increase mCPR to meet the 60% target by 2020 stipulated in National Health Sector Strategic Plan IV (22, 28).
Implants, injectables, and pills were the most common modern methods used by women in our study. The DHS also showed injections, implants and pills to be three of the common contraceptives used by WRA nationally . Use of IUCD is still low in Arusha both in this study and in the study by Yusuf et al (2020). According to the TDHS and other studies, knowledge on IUCD and implants among women is high in Tanzania (80%) [10, 30]. Availability of these long-acting reversible methods (LTFPM) is similarly high at health facilities offering FP services in country [10, 25, 27, 30], but service availability and readiness assessment (SARA) survey showed higher availability of implants at health facilities than IUCD (27). Studies have shown that limited skills among providers in inserting IUCD is a key bottleneck in many SSA countries including Tanzania [28, 30]. It is possible that provider’s skills in IUCD influences the availability of this method to clients. Qualitative studies could look into why women prefer implants to other methods in order to help in designing counseling.
Similar to previous DHS survey results, in Arusha, 7 in 10 women who use modern contraceptive methods, obtain their methods from the government health facilities . The government has been working with private partners to improve provision of FP services in Tanzania. As such, we note that pharmacies are also a major source of methods, being reported by approximately 13% of the women who use modern methods in this study. Pharmacies are opened for longer hours than outpatient departments in most health facilities, thus they become a preferred source of methods for women who are out of stock or need emergency contraceptives . Pharmacies and drug stores can be important potential sites in improving availability and access of methods especially emergency methods, after taking into consideration regulatory and training issues [31–33].
In this study, women cited time to attend health facilities while leaving income generating activities, lack of childcare, and hospital administration fees as common challenges in going to health facilities for FP services. Community distribution of modern contraceptives like oral contraceptive pills, condoms and emergency methods by trained community health workers (CHWs), may be a strong complementary strategy in improving uptake and use of methods given the challenges reported by women in this study. CHWs may also contribute in improving contraceptive use in the area, given the four common methods mostly used by the women must be accessed in facilities. CHWs may help to identify women who have unmet need i.e. need the contraceptive method but are not using and refer them to the nearest health facilities for counseling and services for implants and injectables as shown in Malawi, Democratic Republic of Congo and Burkina Faso [34, 35]. CHWs may also help to address myths and misconceptions of using modern contraception . Use of community providers to improve CPR is one of the strategies in reproductive, maternal, newborn, child and adolescent health (RMNCAH) strategic plan of 2016–2020 in Tanzania, but there is a need for regions and districts to develop local specific strategies on how to operationalize and implement this strategy including outreach services.
Marital status and parity were independently associated with modern contraceptive use. TDHS and other studies have also observed a higher proportion of married women using modern contraceptives than single women (7, 12, 14, 16). Analyses from multiple countries have shown that married/ cohabiting women tend to use long-term reversible contraceptives (LTRCs) than single women (14). Women in stable partnership maybe in a better position to plan when they want another child compared to single women hence higher prevalence of contraceptive use (14, 15).
The strength of this study lies in the fact it was a community-based study, utilizing the random selection of participants and low refusal rate. This may increase generalizability of the results in northern zone, which has similar characteristics to Arusha region. Cross sectional design limits inference of temporal relationship in the observed associations.
To conclude mCPR among WRA in Arusha is at 47% and can be improved. Strategies to expand use of modern contraceptives using community channels like Community Health Workers and existing groups need to be improved. Public-Private Partnership need to be strengthened and engage private health facilities and others like pharmacies in provision of family planning services. Further, there is a need to understand what drives women to lean on certain type of methods and not others while they are equally available at service delivery points.