Provider Segments and Client Care: New Lens on Bias and Product Priorities in Nigeria, Ethiopia, Kenya, Burkina Faso, and Pakistan

Paper co-authored with Steve Kretschmer, Allie Gugliotti, Trisha Wood Santos, Grace Njoroge, Hina Murtaza, Filza Sikander. Presented at ICFP 2025 in Bogota, Colombia

Background

Family planning providers are pivotal to ensuring equitable access to contraception. Yet, providers' personal beliefs and biases can shape access—particularly for younger women and first-time users. Previous research has documented provider concerns about promiscuity, perceived moral risk, and long-term fertility impacts—concerns that can hinder contraceptive counseling or product provision. These views vary widely across geographies and provider types, including public, private/NGO, and retail sectors.

This paper explores how providers are not a monolithic group. Instead, they reflect distinct psychographic and behavioral profiles—shaped not just by demographics or facility type, but by values, product preferences, and client engagement patterns. We segment providers based on the contraceptive attributes they prioritize (e.g., return to fertility, menstrual side effects, discretion), their actual method mix, and the client profiles they serve. By moving beyond simple provider typologies, this analysis reveals a deeper behavioral logic that governs service delivery decisions and access bottlenecks—offering an evidence base for more nuanced and targeted interventions.

Main Question

Can providers be meaningfully segmented based on shared values, behaviors, and client-serving patterns? This study hypothesizes that providers cluster along psychographic lines defined by their product feature priorities (e.g., secrecy, duration, return to fertility), contraceptive method mix, and tendencies to serve or avoid certain subgroups (e.g., adolescents, nulliparous women). These clusters—rather than standard classifications like sector or training level—may more accurately predict provider behavior and bias, and thereby help tailor training, advocacy, and product rollout strategies.

Methodology

In 2023, probability-based surveys were conducted with n~10,000 family planning providers across five countries—Pakistan, Burkina Faso, Ethiopia, Kenya, and Nigeria (boosted sample for North-South split). Multi-stage random cluster samples stratified by urban-rural were drawn with probability proportional to size (PPS) to ensure representation across public, private/NGO, and retail outlets in urban and rural areas. Data collection included provider attitudes toward contraceptive attributes, reported product mix, and client volumes by age. Multiple ML clustering algorithms were fitted, and the most stable segmentation solution selected to maximize inter-cluster distance and internal coherence.

Results

Five unique provider segments emerged, each present in all countries but at varying levels:

  • High-Volume Progressives: Urban-based with high FP client volume, more likely female, and highly value return to fertility and menstrual normalcy. Tend to offer a balanced method mix.

  • Youth-Focused Ruralists: Predominantly rural, with a high proportion of clients under 25—especially under 18. Prioritize return to fertility and favor implants and injectables.

  • Discreet Veterans: Most experienced providers, especially in Kenya. Prioritize client privacy and discreet methods. Lean toward long-acting methods like implants and injectables.

  • New Traditionalists: Least experienced. More likely to provide condoms and daily pills. Show minimal concern for secrecy and have the lowest share of adolescent clients.

  • Unconcerned Generalists: Display low prioritization of return to fertility or menstrual side effects. More open to serving younger clients (18–24), with varied product provision.

Segment distribution differed by geography. For instance, Youth-Focused Ruralists were more prevalent in Northern Nigeria, while Discreet Veterans were more prominent in Kenya. These segment patterns were not reducible to provider type or sector alone, reinforcing the importance of psychographic insights.

Contribution

Traditional segmentation of providers by cadre or sector overlooks attitudinal and behavioral drivers that shape contraceptive access. This study introduces a psychographic segmentation approach, identifying distinct provider personas based on values, service patterns, and method preferences. These profiles transcend national and institutional boundaries and present actionable levers for designing tailored interventions.

For example, Youth-Focused Ruralists could be prioritized for youth-focused method introduction and peer-supported outreach strategies. Discreet Veterans might be leveraged for promoting LARCs in high-stigma environments. New Traditionalists may benefit from tailored training that builds comfort with serving unmarried adolescents or expands familiarity with discreet options.

By understanding not just who providers are, but what they believe and how they behave, programs can more effectively address access constraints and shape demand-responsive delivery models. The segmentation also provides market sizing data, allowing implementers to estimate the reach and impact of targeting specific provider profiles.

Ultimately, this work advances the provider behavior change field by offering a framework for evidence-based segmentation and strategy design, emphasizing that tailored engagement—rooted in provider mindset, not just setting—can meaningfully improve contraceptive access and quality of care.