Quality and costs of family planning as elicited by an adolescent mystery client trial in Nigeria

Results are presented from a rural reproductive health project in Delta State of Nigeria. A baseline survey of Family Planning clients revealed that only 2 percent of adolescents were utilising the services. Therefore four adolescents, two males and two females posing as two couples, were used as mystery clients to assess providers response to adolescents, as well as the adolescent perspectives on the quality and costs of the family planning services in the clinics they visited. This was complemented with a participatory rural appraisal of the communities. The adolescent mystery clients reported that some providers were surprised to see them, were judgemental, and engaged them in religious counselling. The adolescents found the services unsatisfactory, but the costs were affordable. In the participatory rural appraisal, the communities found the cost of contraceptives affordable despite a recent price increase of 20-150% across the different contraceptives. Emerging practices that were detrimental to adolescent reproductive health were also discovered and innovative approaches for promoting access to reproductive health information by out-of-school adolescents through the use of artisan trade associations and home videos are suggested.