Accessibility and Utilization of Family Planning Services among Married Couples in Anambra State, Nigeria: Evidence from the Three Senatorial Districts

Abstract Background: Family planning is a cost-effective public health intervention that improves maternal and child health, promotes reproductive autonomy, and supports sustainable development. Despite sustained investments in family planning programmes in Nigeria, modern contraceptive utilization among married couples remains suboptimal. Although awareness of contraceptive methods is generally high, inequities in access to quality family planning services continue to constrain utilization. Evidence on how multidimensional accessibility influences family planning utilization among married couples in Anambra State remains limited. Objective: This study assessed the accessibility and utilization of family planning services among married couples across the three senatorial districts of Anambra State, Nigeria, and examined the socioeconomic, sociocultural, and health-system factors associated with contraceptive utilization. Methods: A community-based cross-sectional analytical study was conducted among 422 married couples selected through a multistage sampling technique. Data were collected using a structured interviewer-administered questionnaire and analyzed using descriptive statistics, Chi-square tests, one-way analysis of variance, and binary logistic regression at a 5% level of significance. Results: Awareness of family planning services was high; however, utilization varied across the three senatorial districts. Greater accessibility—including geographical proximity, affordability, contraceptive commodity availability, favourable provider attitudes, and perceived service quality—was significantly associated with higher contraceptive utilization. Educational attainment, household socioeconomic status, partner support, reproductive health knowledge, and selected health-system characteristics were significant determinants of utilization, while accessibility remained the strongest independent predictor. Conclusion: Improving family planning utilization requires interventions that strengthen equitable access to high-quality services, ensure uninterrupted contraceptive commodity availability, promote respectful client-centred care and male involvement, and address socioeconomic and health-system barriers to reproductive healthcare.