National Consultancy: Study on Determinants of Family Planning uptake in Liberia

Background and Study Justification:

In Liberia, 24% of married women and 45% of sexually active unmarried women are currently using a modern method of contraception. Injectables, implants, and pills are the most commonly used methods. The country has a high unmet need for family planning, with approximately a third of women who have not used any modern method of contraception for the past 2 to 3 decades. Liberia has a narrow method mix, with clients’ preferences skewed toward one method, leaving other methods, including long-acting reversible methods, underutilized.

About 2/3 of users opt for the injectable methods, while implants, IUCDs, and other methods are used marginally. What determines a high preference for injectables has not been documented.

According to the 2020 Liberia Demographic and Health Survey report, 47% and 16% of women desire contraception for birth spacing and limiting, respectively; however, most women are currently using only one long-acting reversible method, while other, more reliable, longer-acting methods, such as implants and IUDs, are available. Injectables account for 60% of all contraceptive use, while implants account for 20%, and the remaining products, including IUDs, Female and Male sterilization, constitute less than 10% or negligibly lower.

Additionally, there are regional variations in uptake, with the north and south-central regions experiencing lower modern Contraceptive Prevalence Rate (mCPR), ranging from 17% to 23%, compared to the southeastern region, where the mCPR is much higher (34% to 45%) than the national average of 24%. The southeastern counties have demonstrated a greater appreciation for Family planning methods, with a 41% reduction in teen pregnancy from 2013 to 2020. This level of progress, unfortunately, has not been achieved in the counties with the largest population in the country. It appears that childbearing preferences, including among adolescent girls, remain quite high in counties like Lofa, Nimba, Margibi, Bong, Grand Bassa, and Montserrado, evidenced by the low use of modern contraceptives and a lesser use of some Long-acting methods.

Behaviors, attitudes, and practices play an important role in the choices of using family planning methods and the use of the services overall. The promotion and use of effective method choices are affected by attitudes and behaviors that play a significant role in the preference for methods. A peer review document indicated that women’s attitudes towards family planning may be influenced during childhood and are generally acquired through direct experience, reinforcement, imitation, and social learning. In human development, once an attitude or behavior has been cultivated and learned, there can be resistance to change. Studies have shown that most women know of the benefits of family planning methods, but are not using any modern method, and many who opt to use services have a high dropout rate.

Essential to note is that the individual’s attitude towards family planning methods is also influenced by characteristics such as economic, social, cultural, and environmental factors, location, age, education, traditional beliefs, family type, and even exposure and level of knowledge. These factors play a significant role in translating the individual’s knowledge into behaviors or actions. An individual may acquire knowledge about contraceptives and combine that knowledge with previous exposure, beliefs, education, positive or negative, and then adopt a certain behavior towards acceptance of the intervention and/or a specific method. Fertility preferences, value for childbearing, national population policies, and national health policies also influence the uptake of family planning. Health care providers’ attitude and behavior toward clients, including counseling, all contribute to the client’s level of perception and acceptance of contraception.

It is unclear whether the social determinants of family planning use have an impact on the slow use of some contraceptive methods, such as implants, intrauterine devices (IUDs), and female condoms. The low use of key contraceptive methods could be driven by factors associated with health facilities’ functions. None of these issues has been documented in understanding the behavior of clients in designing or redesigning the national family planning program to improve family planning service delivery and increase uptake.

Traditional gender roles of men and women in social relationships also define behaviors that determine the uptake of family planning. In many instances, this is generally due to individuals’ biased perception and prejudiced attitude towards modern methods. Overall, the determinants of family planning can have an impact on the use of contraception and subsequently the fertility status of populations.

Understanding the social and structural determinants of family planning uptake is key to providing culturally responsive and client-centered care. Effective screening of clients as well as access to a wide range of methods offered by providers allows quality service delivery that ensures a balanced rights-based approach to comprehensive family planning interventions.

Against this background, UNFPA is commissioning this study to understand the determinants of family planning in selected counties to determine factors associated with the low use of some methods, including implants, IUDs, female condoms, and others.

Purpose of consultancy:

The consultancy is generally focused on the demand side of Family Planning as it seeks to understand the behavior, attitude, practice, and drivers for contraception use among current and potential users vis-à-vis their reproductive objectives and method preferences. Additionally, the study will also aim to understand factors associated with the low use of some contraceptive methods. Cognizant of the fact that some factors may be associated with the supply side of the spectrum, the study will engage elements of the health care delivery system to understand associated factors that could impact low use of these methods. The objective in this study is therefore two-fold as follows:

1. To investigate the socio-cultural and structural determinants influencing the uptake of modern contraceptives among current and potential users within counties exhibiting low modern Contraceptive Prevalence Rates (mCPR); and

2. To identify the supply-side factors contributing to the underutilization of modern contraceptives.

Scope of work: (Description of services, activities, or outputs)

As a cross-sectional study, it aims to document the characteristics, behaviors, and attitudes of potential and current users of family planning in six counties (Montserrado, Bong, Lofa, Nimba, Margibi, and Grand Bassa) as it relates to the uptake of methods and method choices.

The consultant is expected to design and coordinate data collection across the six counties. Special focus on adolescent and youth beneficiaries will be key to defining the social determinants of family planning and contraceptive use among women and young girls of reproductive age.

The role of key influencers on women’s and girls’ behavior and practice in the context of contraceptive use is crucial. Therefore, engagement of men, boys, parents, and guardians will be important in understanding perspectives and the level of influence these members of the family and community can have on the decision of women and girls as it relates to the use of contraceptives.

This study will focus on identifying and analyzing the supply-side factors that hinder the optimal utilization of modern contraceptives within public and private healthcare facilities across the targeted counties. The scope of the research encompasses system-level operations, health facility management, service delivery practices, and healthcare provider dynamics. To capture a comprehensive picture, the study will employ a mixed-methods approach. Quantitative data will be collected through structured facility audits to assess stock-outs, commodity management, range of available methods, equipment readiness, and service costs. Concurrently, qualitative data will be gathered using semi-structured key informant interviews with facility managers and district health officers, as well as focus group discussions with frontline healthcare providers (nurses, midwives, and community health workers). This qualitative arm will explore critical operational barriers, including provider bias, training gaps, workload challenges, and structural bottlenecks in service delivery. By triangulating quantitative service availability data with qualitative insights into staff capacity and institutional constraints, the study will systematically pin down the primary supply-side barriers limiting contraceptive access and choice.

The consultant is expected to adopt a study design suitable for the study type based on the country context.

Methodology

The assessment will employ a mixed-methods approach, integrating quantitative and qualitative data through participatory and inclusive frameworks. While the consultant will propose a detailed methodology during the inception phase for UNFPA validation, data collection will include Key Informant Interviews (KIIs) with major stakeholders, Focus Group Discussions (FGDs), and interviews with women of reproductive age (15-49 years).

Expected results:

1. Inception Report
2. Study Protocol
3. Field Mission Report on Data Collection
4. Workshop report on the review and validation of the study findings
5. Draft study report
6. Final Study Report

Duration and working schedule:

Deliverables

Timeline

Inception report outlining the study methodology, scope, desk review and work plan.

10 days

Study Protocol

15 days

Field Mission Report on Data Collection

30 days

Draft Study Report

45 days

Final Study Report

60 days

Place where services are to be delivered:

The study will be conducted in all six counties (Montserrado, Bong, Margibi, Lofa, Nimba, and Grand Bassa), with Monrovia being the main station of the consultant.

Delivery dates and how work will be delivered (e.g., electronic, hardcopy, etc.)

Over 60 days from August to October 30, 2026, the consultant is expected to conduct and finalize the family planning study.

Monitoring and progress control, including reporting requirements, periodicity format, and deadline:

The Program Specialist for Data and Evidence will manage the consultancy and provide direct, day-to-day oversight of the study. To ensure seamless implementation, the consultant will receive all necessary technical and administrative support. In accordance with the project timeline, all deliverables will undergo an initial technical review by the Specialist before being submitted to the Deputy Representative for final clearance and approval.

Expected travel:

The consultant is expected to travel to selected counties to coordinate the study and conduct a few interviews.

Supervisory arrangements:

The Consultant will be under the supervision of the Programme Specialist, Data and Evidence.

Required expertise, qualifications, and competencies, including language requirements:

The Consultant will meet the following criteria:

• A seasoned Public Health Specialist, a social scientist with 7 to 10 years’ experience
• Proven experience in the conduct of qualitative and quantitative studies in a similar context
• Excellent writing and organizational skills in workshop facilitation
• Excellent analytical skills and a high capacity to synthesize information.
• A thorough knowledge of the United Nations system in general and of UNFPA in particular would be an asset.
• Fluency in English

UNFPA Country Office in Liberia will ensure that adequate and timely administrative support services are provided.

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