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Expanding access to family planning (FP) is a principal objective of global family planning efforts and has been a driving force of national family planning programs in recent years. Many country programs are working alongside with the international family planning community to expand access to modern contraceptives. However, there is a challenging need for measuring all aspects of access. Measuring access usually requires linking information from multiple sources (e.g., individual women and facilities). To assess the influence of access to family planning services on modern contraceptive use among women, we link four rounds of individual women and service delivery points survey data from PMA2020 in Kinshasa. Multilevel logistics regression on pooled data is performed to test the influence of facility-level access factors on individual-level contraceptive use. We add variables tailored from a conceptual framework to cover elements of access to family planning: administrative access, geographic or physical access, economic access or affordability, cognitive access, service quality, and psychological access. We find that the effect of community and facility-level access factors varies extensively but having fewer stocked-out facilities and more facilities with long-acting permanent methods (LAPM) increases the odds of using modern contraceptives among women in Kinshasa. Our study shows that reliable supply chain with a broad array of method mix will increase the odds of modern contraceptive use at community level among women in Kinshasa. Using to community-oriented practices and service delivery along with empowering women to make health-related decisions should become a priority of family planning programs and international stakeholders in the country., Competing Interests: The authors have declared that no competing interests exist.

Background: The Family Planning 2020 (FP2020) initiative, launched at the 2012 London Summit on Family Planning, aims to enable 120 million additional women to use modern contraceptive methods by 2020 in the world's 69 poorest countries. It will require almost doubling the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points to achieve the goal. We examined the post-Summit trends in modern contraceptive prevalence rates in nine settings in eight sub-Saharan African countries (Burkina Faso; Kinshasa, DR Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda). These settings represent almost 73% of the population of the 18 initial FP2020 commitment countries in the region., Methods: We used data from 45 rounds of the Performance Monitoring and Accountability 2020 (PMA2020) surveys, which were all undertaken after 2012, to ascertain the trends in modern contraceptive prevalence rates among all women aged 15-49 years and all similarly aged women who were married or cohabitating. The analyses were done at the national level in five countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) and in selected high populous regions for three countries (DR Congo, Niger, and Nigeria). We included the following as modern contraceptive methods: oral pills, intrauterine devices, injectables, male and female sterilisations, implants, condom, lactational amenorrhea method, vaginal barrier methods, emergency contraception, and standard days method. We fitted design-based linear and quadratic logistic regression models and estimated the annual rate of changes in modern contraceptive prevalence rates for each country setting from the average marginal effects of the fitted models (expressed in absolute percentage points). Additionally, we did a random-effects meta-analysis to summarise the overall results for the PMA2020 countries., Findings: The annual rates of changes in modern contraceptive prevalence rates among all women of reproductive age (15-49 years) varied from as low as 0·77 percentage points (95% CI -0·73 to 2·28) in Lagos, Nigeria, to 3·64 percentage points (2·81 to 4·47) in Ghana, according to the quadratic model. The rate of change was also high (>1·4 percentage points) in Burkina Faso, Kinshasa (DR Congo), Kaduna (Nigeria), and Uganda. Although contraceptive use was rising rapidly in Ethiopia during the pre-Summit period, our results suggested that the yearly growth rate stalled recently (0·92 percentage points, 95% CI -0·23 to 2·07) according to the linear model. From the meta-analysis, the overall weighted average annual rate of change in modern contraceptive prevalence rates in all women across all nine settings was 1·92 percentage points (95% CI 1·14 to 2·70). Among married or cohabitating women, the annual rates of change were higher in most settings, and the overall weighted average was 2·25 percentage points (95% CI 1·37-3·13)., Interpretations: Overall, the annual growth rates exceeded the 1·4 percentage points needed to achieve the FP2020 goal of 120 million additional users of modern contraceptives by 2020 in the select study settings. Local programme experiences can be studied for lessons to be shared with other countries aiming to respond to unmet demands for family planning. The findings of this study have implications for the way progress is tracked toward achieving the FP2020 goal., Funding: The Bill & Melinda Gates Foundation., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016., Setting: We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo., Participants: Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA., Design: We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016., Results: In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30)., Conclusions: The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Objectives: To examine family planning outcomes among women living in military camps in Kinshasa, Democratic Republic of the Congo, and compare these outcomes with a representative sample of non-military women in Kinshasa., Participants: Women of reproductive ages, 15-49 years. We compare two populations: women living in military camps and the general (non-military) population in Kinshasa., Study Design: For sampling, we used a two-stage cluster sampling design, where we first randomly selected enumeration areas (EA), and then randomly selected women within each EA (separately for each of the two populations). We administered a survey on contraceptive use and family planning to all participating women. We use bivariate and multivariate analysis to compare these populations for a range of family planning outcomes., Results: We find many statistically significant differences between women in military camps and general female population of Kinshasa. Although they do not have more children, women in military camps are less likely to be using contraception (all methods OR 0.24, 95% CI 0.11 to 0.53; modern methods OR 0.25, 95% CI 0.08 to 0.79; traditional methods OR 0.41, 95% CI 0.24 to 0.71) and less knowledgeable about many family planning methods (less likely to have heard of implants (OR 0.23, 95% CI 0.11 to 0.48), injectables (OR 0.19, 95% CI 0.08 to 0.44), condoms (OR 0.23, 95% CI 0.12 to 0.47), withdrawal (OR 0.05, 95% CI 0.02 to 0.17) and rhythm (OR 0.12, 95% CI 0.03 to 0.44) methods), while at the same time they are more likely to want to limit their births (OR 5.17, 95% CI 2.52 to 10.62), and less likely to have obtained their preferred family planning method (OR 0.14, 95% CI 0.03 to 0.64)., Conclusions: Women in military camps in Kinshasa appear to be an important and underserved population with regard to family planning. Our results suggest that women in military camps have limited access to modern family planning methods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)

While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment., Methods: Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on "readiness" to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output., Results: We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as "ready" to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by family planning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were associated with CYP: type of health facility, length of time in operation, and number of contraceptive methods available. Clinics generated higher (3-month) CYP than hospitals and health centers by 65.3 and 61.5 units, respectively (P<.01). The mean CYP for facilities in operation for 4-6 years was 26.9 units higher (P<.05), and 50.2 units higher for those operating 7+ years (P<.01), than the reference group of facilities in operation for 1 year or less. For each additional method available at a facility, CYP increased by almost 8 units (P<.01)., Conclusions: Findings from these surveys suggest that lack of physical access is not the defining reason for low contraceptive use in Kinshasa, although it is highly likely that other service-related factors contribute to low service utilization. The results contributed to increasing the momentum for family planning in the DRC in many ways, including mobilizing partners to increase contraceptive access and increasing donor investment in family planning in the DRC., (© Kayembe et al.)