Access to Sexual and Reproductive Health Services

Welcome to the programmatic area on access to sexual and reproductive health (SRH) services within MEASURE Evaluation’s Family Planning and Reproductive Health Indicators Database. This is one of the subareas found in the service delivery section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications.

  • A primary strategy of health programs is to increase access to services.  Different approaches to increasing access include establishing additional facilities, training more health workers, increasing outreach activities, and so forth. Access to services is not merely an issue of physical distance, but one that involves other factors as well.
  • The indicators presented in this database measure access along multiple dimensions: geographical/physical, economic, administrative, and psychosocial.
  • Key indicators to monitor and evaluate access to services can be found in the links at left.

 

Full Text

A primary strategy of health programs is to increase access to services.  Different approaches to increasing access include establishing additional facilities, training more health workers, increasing outreach activities, and so forth. Despite the widely acknowledged importance of access as a key feature of the supply environment, this factor is not routinely assessed in reproductive health (RH) program evaluation.

Much of the previous research in this area has focused on one aspect or dimension of accessibility: geographic (or physical) access.  In this context, access (or accessibility) refers to the degree of difficulty in reaching or obtaining RH services.  Researchers have proposed a variety of measures pertaining to the distance to supply and to service points, the time required to reach these points, and the density of service/supply points within a specified geographic area.  In the case of family planning, the evidence to date tends to confirm the relevance of geographic proximity to contraceptive services as an important determinant of contraceptive use.

Some researchers have distinguished between the terms "availability" (to describe whether a particular method or service is provided) and "accessibility" (to denote a continuum of effort required to obtain services) [Bertrand et al., 1995].  However, the terms are often used interchangeably, and in this database, "access" is used to reflect the degree of difficulty (or ease) in accessing services.

Access to services is not merely an issue of physical distance, but one that involves other dimensions as well (Chavoyan, Hermalin, and Knodel, 1984; Foreit et al., 1978).  Foreit et al. suggested the following as relevant dimensions or elements of accessibility (the authors used the term "availability" in the original text): geographic or physical, economic, administrative, and cognitive. The indicators that follow measure access along multiple dimensions: geographical/ physical, economic, administrative, and psychosocial.

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References:

Bertrand, J.T., K. Hardee, R. Magnani, and M. Angle. 1995. "Access, Quality of Care and Medical Barriers In Family Planning Programs." International Family Planning Perspectives 21, 2: 64-69,74.

Chayovan, N., A. I. Hermalin, and J. Knodel. 1984. "Measuring Accessibility to Family Planning Services in Thailand." Studies in Family Planning 15, 5:201-211.

Foreit, J.R., M.E. Gorosh, D.G. Gillespie, and C.G. Merritt. 1978. "Community-based and Commercial Contraceptive Distribution: An Inventory and Appraisal." Population Reports Series J, 19, March: J1-J29.

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