Do service providers in Tanzania unnecessarily restrict clients' access tocontraceptive methods?

Context: Even where family planning services are physically accessible and economic barriers to access are few, medical barriers to contraceptive serv ices-such as overspecializatian, eligibility restrictions, process hurdles and provider bias-can limit women's use of services Methods: Data from the 1996 Tanzania Service Availability Survey are used t o analyze the prevalence of medical barriers by type of provider; by type o f facility and by urban-rural location. Results: Relatively high proportions of providers restrict eligibility by a ge, particularly for oral contraceptives the most widely used method among Tanzanian women. Between 79% and 81% of medical aides, trained midwives, ma ternal and child health aides and auxiliary staff (the most common types of family planning service providers in rural Tanzania) impose age restrictio ns for the pill. Among all providers, 10-13% report that there is at least one modern method they would never recommend, and 13% report having sent a client home until her next menses, an inappropriate process hurdle for the provision of most hormonal methods. In the aggregate, these restrictions se verely limit access to contraceptives for certain groups of women. For exam ple, young, unmarried women who are not menstruating at the time of their v isit would encounter one or more barriers or process hurdles at more than 7 0% of urban facilities and at 80%; of rural facilities. Conclusions: If preservice and in-service training and supervisory visits p laced greater emphasis on compliance with the Tanzanian National Family Pla nning Program's service guidelines and standards, providers' unnecessary re strictions on contraceptive use might be reduced, and ultimately eliminated .