Percent of facilities with non-medical restrictive eligibility criteria
Eligibility criteria of a non-medical nature, mandated by the service facility or organization, which limit access to reproductive health (RH) services for specific categories of individuals (e.g. youth, particularly unmarried females; commercial sex workers; individuals from a certain tribe or ethnic group; etc.)
This indicator is calculated as:
(# of facilities with non-medical restrictive eligibility criteria/ Total # of medical facilities) x100
Eligibility criteria for services offered by the program
Program documents outlining policies and regulations; interviews with staff
This indicator identifies the existence of barriers to services in the form of unnecessary formal program policies, regulations, and procedures; such restrictions, mandated at the policy/program level, exceed those justified on medical grounds. Typical restrictive criteria for different RH services include the following:
- Age, parity, marital status, and/or spousal consent;
- Requirements for blood tests or pelvic examinations prior to the distribution of oral contraceptives;
- Requirements for multiple visits to receive certain contraceptive methods (e.g., IUDs);
- Requirements of direct physician involvement in the provision of services; and
- A required waiting period of several days between counseling for voluntary surgical contraception and the actual procedure.
Sexually Transmitted Infections (STIs):
- Age, marital status, spousal consent;
- Partner notification; and
- Waiting period for HIV test results.
- Age, parity, marital status, spousal consent; and
- Requirements for direct physician involvement in provision of services (when other appropriately trained clinical staff [e.g., midwives] could provide the same service).
Adolescent Reproductive Health Services:
- Age, marital status; and
- Parental notification or consent.
Abortion and Postabortion Care:
- Parental or spousal consent prior to procedure or treatment;
- Inappropriate judicial requirements (e.g., rape may be a legal indication for elective abortion, and women are not permitted to obtain the service without “proof” of the rape, which might be a court order);
- Provision of uterine evacuation for incomplete abortion only in an operative theatre;
- Provision of uterine evacuation for incomplete abortion only under general anesthesia;
- Provision of uterine evacuation for incomplete abortion only by a physician;
- Inappropriate clinical criteria for use of manual vacuum aspiration for treatment of incomplete abortion; and
- Inappropriate criteria for contraceptive method provision following treatment of incomplete abortion.
Administrative barriers to access occur less frequently for STI/HIV services, which tend to be provided to those who seek treatment.