# Provider attitudes, long-acting reversible contraception, and quality of care: A mixed methods study in Tanzania

> **NIH NIH F31** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2022 · $38,745

## Abstract

Abstract
Global contraceptive programs increasingly promote the use of long-acting reversible contraception (LARC)—
implants and intrauterine devices (IUDs)—to reduce the 121 million unintended pregnancies each year.
LARCs are highly effective, low maintenance, long lasting, and have lower rates of discontinuation. Unlike
other reversible contraceptive methods, LARCs require removal by a clinician to discontinue use. These
features have caused providers, advocates, and scholars to promote LARC uptake globally—however, a
LARC-first approach may infringe on a client’s right to choose what type of contraceptive method to use and
when to stop using a method. Contraceptive programs targeting reduction of unintended pregnancy may
engender provider attitudes and behaviors that favor LARCs and restrict client autonomy and choice in
contraceptive care. There is little evidence on these dynamics from low- and middle-income countries (LMICs)
where LARC use has been explicitly embedded in country-specific contraceptive uptake goals. This study will
fill a gap in the literature by (1) describing providers’ attitudes, beliefs, and care practices surrounding LARC-
related care, (2) modeling the influence of provider attitudes on clients’ LARC uptake and LARC removals, and
(3) assessing the association between quality of care and LARC uptake and LARC removals in a sample of 73
facilities in Dar es Salaam, Tanzania. Tanzania is a compelling setting to study provision and removal of
LARCs as use of implants has risen by 1240% since 2004. The Tanzanian government has set explicit targets
for increasing LARC use—aiming for 20% and 13% increases in implant and IUD use respectively between
2019 and 2023, increasing the structural emphasis on LARC uptake. A focus on the quality of services is
essential to ensure the emphasis on contraceptive uptake has not come at the expense of high-quality,
person-centered contraceptive care. The study utilizes three data sources: 29 in-depth interviews with
contraceptive providers, a client exit survey capturing 13,036 contraceptive clients seeking either a method of
contraception or a LARC removal, and a survey of 259 providers. The proposed study will employ constant
comparative thematic qualitative methodology to examine provider attitudes and care practices in the
qualitative interviews and hierarchical Bayesian models to jointly model provider- and client-level survey data.
Understanding the influence of provider attitudes on LARC uptake, removals, and quality of care will facilitate
targeting interventions to address poor quality care.

## Key facts

- **NIH application ID:** 10607843
- **Project number:** 1F31HD111291-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Alexandra Wollum
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $38,745
- **Award type:** 1
- **Project period:** 2022-12-01 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10607843

## Citation

> US National Institutes of Health, RePORTER application 10607843, Provider attitudes, long-acting reversible contraception, and quality of care: A mixed methods study in Tanzania (1F31HD111291-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10607843. Licensed CC0.

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