The different modern contraceptives were largely acceptable to the respondents, although the level of acceptability varied across the states, with the lowest levels of acceptability recorded in the two northern states of Kano and Adamawa states. The fact that the lowest levels were recorded in these two states is potentially related to the fact that the North had lower contraceptive prevalence rate than the South . This could be as a consequence of cultural, religious and educational factors. Some authors found that religion played a major role in acceptance of modern contraceptives in northern Nigeria .
Low level acceptability of the modern contraceptives in some states leads to women unmet needs and it also traps families into poverty and leads to diseases associated with maternal health . These points to the need to increase awareness about contraceptives especially in the northern states so as to demystify contraception and enable people make good contraceptive choices. The higher acceptability in the urban areas compared to the rural areas reflects the higher educational status of urban dwellers on acceptability of the contraceptives. The general high level of acceptability implies that if the contraceptives are readily available in both the public and private sectors and are affordable, the level of use of the contraceptives will increase.
It was interesting to find out that most of the contraceptives were from private sector, especially the private drug retailers (patent medicine vendors (PMDs) and pharmacy shops. Several studies that were undertaken in Nigeria, Ghana and Kenya have also shown that although some people source their contraceptives from the public sector, the contraceptives are mostly sourced from the private sector such as the PMDs, pharmacies and private hospitals [16–19]. Other previous studies also found that some contraceptives were mainly obtained from the public sector in Nigeria . However, a study found that public facilities were the major source for contraceptives and that the government played a major role in the provision of the services . The implication is that the importance of the private sector should be recognised by policy makers and that private sector should be incorporated in the formal deployment of modern contraceptives for ensuring widespread availability of the commodities.
It was apparent that the level of proximity of the different providers to consumers had an effect on peoples’ sources of contraceptives. Patent medicine dealers and pharmacy shops being the most readily accessible providers were the major sources of the contraceptives in this study. It could be argued that providers located far from users could result to poor access and usage. However, the differential level of use from different providers could also be a result of relative availability of different contraceptives in different providers and privacy people get while accessing different contraceptives as was found by a study done in Kenya increased use of the private sector was due to their proximal location to the consumers and confidentiality and privacy of information given to the patient . However, the finding on the sources of different contraceptives was insightful. It appeared that consumers were knowledgeable enough to patronise hospitals for the higher tech contraceptives (IUDs, Injectibles and Implant), whilst they visited informal private health providers and drug retailers for condoms and OCP. The finding should be used to inform programmatic designs on the involvement of the private retailers in official interventions to scale-up the availability of contraceptives. The capacity of the drug retailers should be developed further, especially in the information that they provide the consumers since some studies have found that a significant amount of information given by some these health providers could be incorrect .
There were some levels of inequities in acceptability and sources of the contraceptives. The least poor (highest) SES groups found it easier to source or access contraceptives from different providers than the poorer SES groups. Other studies also found inequities in access to modern contraceptives by different SES groups . Some studies argue that people in the poorer SES may not be aware of policies designed to increase their access to reproductive services (such as the contraceptives) . Strategies to promote equity in acceptability and access to the contraceptives should include the use of innovative health education campaigns at the community to create the awareness of the existence of the national policy on abolition of user fees for modern contraceptives in the public sector in Nigeria. Some authors argued that women in the lowest SES have the highest level of unmet needs and are least likely to access, spend on and use modern contraceptives .
There were also SES and geographic inequities in the sources of the different contraceptives, with the better-off quintiles generally mostly procured their contraceptives from government and private hospitals and pharmacy shops, whilst the worse-off quintiles mostly procured their contraceptives from patent medicine dealers. This could be a function of both financial and geographic access. Nonetheless, it was argued that despite the interest in determining socio-economic inequality in access to modern contraceptives, only few factors associated with it are known .
However, the study has some limitations and a major one was the fact that the questionnaire was in English language. However, the interviewers were encouraged to use the local languages to explain some of the points and ask some of the questions to the respondents. This was possible since the interviewers were recruited from the respective states so as to help to eliminate language barriers. The lack of a supportive qualitative study that would have been used to deeply probe the reasons for the different levels of the acceptability of the contraceptives in the different geographic settings is another limitation of the study. Qualitative studies should be undertaken in the future so as to gain better understanding of the factors behind the levels of acceptability and sources of different contraceptives in different contexts and states. Also, detailed work on potential role of the public and private sectors on improving equity of access to modern contraceptives should be the subject of future studies.