Assessment of Contraceptive Stock-Out and Its Associated Factors in Public Health Facilities of Hawassa City, Southern Ethiopia: A Cross Sectional Study

Assessment of Contraceptive Stock-Out and Its Associated Factors in Public Health Facilities of Hawassa City, Southern Ethiopia: A Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Contraceptive Stock-Out and Its Associated Factors in Public Health Facilities of Hawassa City, Southern Ethiopia: A Cross Sectional Study Wosen Zeleke, Legesse Adane This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8613593/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Family planning services enable individuals to make informed reproductive choices. In Ethiopia, frequent stock-outs persist despite national guidelines and supply chain reforms. This study assessed the impact of these stock-outs on reproductive health outcomes and family planning services in Hawassa City. Objectives The main objective to assess contraceptive stock-outs and its associated factors in public health facilities of Hawassa City, Sidama Ethiopia. Method A facility-based cross-sectional survey was carried out at four health centers and three randomly chosen public hospitals in Hawassa City from May 20 to June 30, 2025. FP records and structured questionnaires were used to gather data. Data were coded, entered into Kobo Toolbox, and SPSS version 26 was used for analysis. Both inferential and descriptive statistics were used. To evaluate relationships between dependent and independent variables, bivariate and multivariate logistic regressions were used. P-values less than 0.05 were regarded as statistically significant. Results 134 (58.5%) of the 229 participants (100% response rate) reported stock-outs lasting two to four weeks, while 83 (36.3%) [95%, CI: (30.1%, 42.5%) reported weekly stock-outs. AOR = 2.44, 95% CI [1.35–4.42], p < 0.003, facilities ≥ 20 km from the district pharmacy (AOR = 2.5, 95% CI [1.3–4.8], p < 0.005), and facilities without trained FP staff (AOR = 3.1, 95% CI [1.4–6.7], p < 0.004) all had higher odds of stock-outs, while updated stock records decreased the likelihood (AOR = 0.4, 95% CI [0.2–0.9], p < 0.02). These structural and organisational factors were significant determinants. The most frequent complaints were from clients (215, 94.1%), service interruptions (38, 16.6%), unmet needs (17, 7.4%), and unplanned pregnancies (15, 6.5%). Conclusion Systemic and organizational problems are the main causes of the frequent contraceptive stock-outs in Hawassa City, which largely result in client discontent and, to a lesser extent, service interruptions, unmet need, and unplanned births. Recommendations: Strengthen supply chains, improve inventory management, enhance staff capacity, prioritize health centers, and address structural barriers to ensure consistent access to all FP methods, particularly LARC, and improve client satisfaction. Contraceptive stock-out family planning health facilities supply Ethiopia Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Women in reproductive ages frequently utilize contraceptives in the modern world. Using contraceptives has many advantages. These include Family Planning (FP), preventing and reducing unintended pregnancies and abortions, promoting maternal health behaviors, lowering pregnancy-related morbidities and mortality, and improving birth outcomes ( 1 – 3 ). It also enables women to exercise their rights of reproductive ( 4 , 5 ). By encouraging longer education, fewer pregnancies, a later and healthier childbearing age, and greater options for income-producing activities, reports also demonstrated that the use of contraceptives gives adults the chance to live meaningful lives ( 3 , 6 ). However, FP has several challenges including issues with supply and management of contraceptive procurement, stock-outs of contraceptives, and lack of access to health facilities ( 7 – 9 ). Among these issues, the global shortage of contraceptives is a major problem, particularly in nations with low incomes ( 8 , 10 – 12 ). When one or more contraceptive choices are not available in a medical facility that regularly offers that technique or that is required by policy to offer that method, it is known as a contraceptive stock out ( 8 ). The absence of one or more FP techniques at service delivery locations is another definition of it. Unplanned pregnancies, higher rates of morbidity and mortality of mothers and children, and increased strain on these regions' public health systems are all consequences of frequent stock-outs of FP commodities (contraceptives) ( 8 , 10 , 13 ). According to reports, the issue of contraceptive stock outs is a major concern worldwide, especially in low- and middle-income countries (LMICs) ( 14 , 15 ). It is a serious concern of Sub-Saharan Africa (SSA) regions of the world. For example, it has been estimated that 218 million women between the ages (15–49 years of age) do not have access to contemporary forms of contraception. Supply chain failures like transportation delays, inefficient procurement, and poor inventory management are among the primary causes; other factors include inadequate forecasting, limited funding, poor logistics data, inadequate human resources, lack of access, and weak logistics systems ( 12 , 13 , 16 – 18 ). As a result, the majority of women (57%) in Southern Asia and SSA experienced unwanted pregnancies, which can result in unintended births, unsafe abortions where access to high-quality services is prohibited by law, maternal deaths, and the loss of years of healthy life ( 19 ). According to a Nigerian study, inconsistent deliveries caused stock-outs in more than 30% of basic health centres ( 12 ). According to a Kenyan study, women have significant challenges when it comes to contraceptive stock outs. Stock-outs were significant obstacles for women in the nation to obtain their preferred form of contraception and a cause for switching to less preferred methods. Health, autonomy, and the capacity to avoid unplanned pregnancy were all directly impacted by this. Issues in the supply chain, such as ineffective planning, acquiring, and distributing family planning supplies, have been connected to causes of contraceptive stock-outs ( 20 ). Similar explanations were offered for Rwanda's current issues with contraceptive stock outs ( 21 ). A qualitative study was conducted in Uganda. The study involved users/clients and providers, and the results showed that (a) women are accustomed to stock-outs and frequently turn to other providers, often switching to another less effective method; (b) stock-outs lead to negative outcomes for women, such as unintended pregnancy, stress, domestic conflict, and increased overall contraceptive costs; and (c) stock-outs also cause providers to face emotional distress, demoralization, blame, declining skills, and decreased demand for their services. The study on the experience and impact of contraceptive stock-outs also showed that that stock-outs were common and prevalent ( 22 , 23 ). Similar study conducted in Mali showed stock out is a problem of in 46% health facilities ( 24 , 25 ). The Ethiopian government is committed to enhancing and promoting the reproductive health of men, women, and youth ( 5 , 26 ). With a reported rise from 6% in 2000 to 41% in 2019, the nation has achieved significant progress in raising contraceptive prevalence rates ( 27 ). Nevertheless, contraceptive stock-outs continue to be a significant problem in spite of these developments. According to a survey conducted in Southern Ethiopia, over 30% of medical facilities encountered contraceptive stock-outs at least once a year. In addition to influencing personal decisions, this supply irregularity compromises the efficacy of national FP initiatives ( 11 ). Furthermore, people may not be able to get their desired method just because it is not available, even if they can pay it and have access to a health institution where contraceptives are regularly supplied ( 28 ). The purpose of this study is to investigate how common stock-outs of reproductive health supplies, such as contraception, are in Hawassa, Southern Ethiopia. The study's findings would (a) demonstrate the frequency of contraceptive stock-outs in public health facilities. (b) provide health facility administrators with baseline data to develop quality care improvement projects, modify staff in-service training, guide local policy changes, and improve supply chain management. (c) help health workers be vigilant about preventing contraceptive stock-outs that disrupt the provision of high-quality services; and (d) serve as a guide for other researchers who wish to conduct similar studies in other locations (health facilities) with a sizable sample size and in various study settings. METHODS Study Area and Period The study was carried out at Hawassa City, Sidama National Regional State, which is situated 275 kilometers south of Addis Ababa, Ethiopia. According to Central Statistical Agency (CSA, 2007), the city's total population was expected to be 506,467; 51.2% of these were female, while the remaining were male ( 29 ). The city has ten public health centers with their own pharmacies and medical supply stores, as well as five government hospitals (two general hospitals, two primary hospitals, and one specialty teaching and referral hospital). This study was conducted in selected health facilities of Hawassa city from June 1–30, 2025. Study Design A facility-based cross-sectional study was conducted. Population Source Population : All public Health institutions in the Hawassa city and their respective staffs Study Population Randomly selected staffs who are working at MCH, store and dispensary of selected health facilities of Hawassa city. Inclusion and Exclusion Criteria : Inclusion criteria staffs who work at MCH, store and dispensary of selected health facilities during the study period. Exclusion Criteria Those staffs who are not voluntary to participate in the study. Sample Size and Sampling Technique The sample size was determined by using a single population proportion formula with a 95% confidence interval, a 5% margin of error, and adding 5% for the non-respondent rate. By using the proportion of 50% the sample size was calculated as follows. Then since the study population is < 10,000 (500 health care providers found in the selected hospitals and health centers), the correction formula was used as follows: nf = ni /1 + ni /𝑁 Sample size= 𝑛f = ni/(1 + ni/N) = 385/(1 + 500/384) = 217.514 ~ 218 (Where N = total number of nurses in randomly selected hospitals and health centers [N = 500] By adding 5% non-response rate (i.e. 0.05*218 = ~ 11) the minimal representative sample size, nf = 229. Therefore, the final sample size was 229. Sampling Technique Three hospitals out of five government hospitals and four health centers out of ten were chosen using a straightforward random sampling technique. Covenant approaches were used to ask the health professionals working at Mother Children Health (MCH), drug stores, and pharmacies. To choose participants, each health facility and its departments were given a proportionate share based on their size (Fig. 1 ). Data Collection Procedure and Instrument Data were collected by trained 5 BSc holder midwives who have experience with reproductive health services. Structured questionnaires were used ( Annex 1 ) to collect data from the participants. The data collectors administered the questionnaires (to the participants) in private settings within the health facilities to ensure confidentiality and encourage honest responses. In order to assess bin cards and inventory management practices of each health facility, data collectors reviewed records of stores and dispensary of the selected health facilities. A supervisor was monitoring the data collection process to ensure data quality and consistency. Data Collection Methods and Instruments Data was collected using structured questionnaires, in-depth interviews, and facility family planning record reviews. Data was collected using direct interviews using the Kobo tool and the instrument was modified and adapted from several investigations and has three parts: socio-demographic issues, pattern of contraceptive stock out, and the consequence of stock out. Data was collected and supervised by BSc nurses who work at family planning with research experience. Variables Dependent Variables Contraceptive stock-out status (Adequate or Inadequate) Independent Variable Socio-demographic characteristics of the respondents : Age, gender, address, marital status, profession, income etc Factors related with health facility : Level/Type of health facility: Primary (health center), secondary (district hospital) or tertiary (referral hospital), health facility location( rural or urban), distance between the health facility and the district pharmacy, management of the HF (referred to as public or faith-based/NGO facilities Factors related with service providers : Availability of trained staff in health facility (Yes or No), frequency of supervision made at the health facility in FP program, availability of Monitoring and Evaluation and ICT tools: Yes or No Inventory Management : Stock Availability, Supply Chain and Logistics Operational Definitions Contraceptive Stock-Out : The unavailability of one or more modern contraceptive methods (e.g., injectables, implants, oral pills, condoms) in a health facility at the time of visit or data collection, lasting for at least one day ( 11 , 23 ) Training in Logistics Management Whether logistics or pharmacy staff have received formal training on contraceptive commodity management within the last two years ( 30 ) Human Resource Adequacy The presence of at least one trained staff responsible for contraceptive logistics and stock management ( 23 ). Forecasting Accuracy The degree to which a facility accurately estimates its contraceptive needs during the reporting period. Assessed through comparison of estimated vs. actual usage and stock-out records ( 13 ) Staff Workload The number of family planning clients served per staff per day or week. This can be categorized as high, moderate, or low ( 31 ). Storage Capacity Availability of dedicated, secure, and adequate space for storing contraceptives in compliance with standard guidelines. Measured as “adequate” or “inadequate” Supervision Frequency of supervisory visits from Hawassa-city Health Bureau or Sidama Region health office regarding FP commodity management ( 32 ). Client Load Average number of FP clients served per month by the facility, based on service records for the last 3–6 months ( 13 ). eLMIS Usage The extent to which a facility uses an electronic Logistics Management Information System for inventory tracking, requisition, and reporting. Measured as “ Yes ”, if used regularly for FP commodities ( 33 ). Data Quality Control Measures To ensure data quality, training and orientation was given to the data collectors by the principal investigator. In order to achieve a good data quality, the questionnaire was prepared in English (Annex 1) and translate into Amharic language ( Annex 2 ) and then back to English to keep its consistency. Pre-test was conducted at Abela health center on 5% of sample size prior to the actual data collection to see for the quality of the data collection tool and to estimate time needed. The completeness and consistency of questionnaire for each respondent was checked at the time of data collection. Data Processing and Analysis After being coded, gathered, and imported into the Kobo toolbox, the data was transferred to SPSS version 26 for analysis. The data was summarized using descriptive statistics, such as means, frequencies, percentages, and standard deviations (SDs). Factors linked to FP utilization were identified through bivariate analysis and variables with a p-value < 0.25 in the bivariate analysis were added to a multivariable logistic regression model. It was employed to observe the independent impact of independent variables on the outcome variable through the control of confounding variables. 95% confidence intervals (CIs) for odds ratios were used to quantify the degree of connection. The cutoff criterion for testing statistical significance was a p-value < 0.05. Variables with noteworthy results were presented in tables, graphs, and charts. Ethical Clearance Pharma College's Institutional Research Review Committee (IRRC) granted ethical clearance. Support letters were prepared for the hospitals, health centers, and Hawaii City Health Bureau, respectively. All participants gave their verbal informed agreement, and the study was kept anonymous by employing unique codes rather than names, IDs, and phone numbers. The freedom to leave the study at any moment and without penalty was explained to the participants. RESULTS Socio-Demographic Characteristics of Participants A total of 229 participants were included in the study and a response rate of 100% was obtained. Most participants were male 212 (92.6%), while females accounted for 17 (7.4%). The mean age of respondents was 35.52 years (SD = 4.0). Regarding professional background, nurses constituted the largest group 128 (55.9%), followed by midwives 48 (21.0%), health officers 38 (16.6%), pharmacists 11 (4.8%), and general practitioners 4 (1.7%). Nearly all respondents 214 (93.4%) had less than 10 years of experience in their current health facility. In terms of educational level, 121 (52.8%) participants held diploma, 100 (43.7%) had a bachelor’s degree, 7 (3.1%) were medical doctors, and 1 (0.4%) had other qualifications. The participants were from different level health facilities; 65 (28.4%) from primary hospitals, 64 (27.9%) from health centers, 54 (23.6%) from referral hospitals, and 46 (20.1%) from general hospitals (Table 1 ). All facilities were located within 20 km of the district pharmacy as mentioned by the respondents and were situated in urban settings. Table 1 The socio-demographic characteristics of the study participants from public health facilities of Hawassa city, Sidama Region, 2025 (N = 229) Variable Category Frequency (n) Percent (%) Sex Male 212 92.6 Female 17 7.4 Age category < 29 years 57 24.9 ≥ 30 years 172 75.1 Years of experience < 10 years 214 93.4 10–20 years 15 6.6 Profession Nurse 128 55.9 Midwife 48 21 Health Officer 38 16.6 General practitioner 4 1.7 Pharmacist 1 0.4 Educational Level BSc 100 43.7 Diploma 121 52.8 Doctor 7 3.1 other 1 0.4 Level of HF/SDP* General Hospital 46 20.1 Health center 64 27.9 Primary Hospital 65 28.4 Referral Hospital 54 23.6 Distance between the HF & District Pharmacy < 20 km 229 100 ≥ 20 km 0 0 *HF: Health facility; SDP: Service Delivery Point Factors Related to Providers, Materials and Tools The responses gathered from the participant of the study showed that most health facilities had the resources needed to provide FP services; almost all facilities had FP-trained staff (228 or 99.6%), and a comparable proportions had FP checklists or job aids available; all participants (229 (100%)) responded that their facilities had FP guidelines and used logistic forms; and the respondents (228 (99.6%)) also mentioned that all the facilities had regular and direct supervision visits, indicating strong support and oversight for FP service delivery (Table 2 ). These results show that resource availability and administrative support for FP services were practically universal in the assessed facilities. Regarding the provision of the FP method, the survey participants responded that the health facilities where they work have oral contraceptives (229 (100%)), Injectables (216 (94.3%)), IUCDs (218 (95.2%), and condoms (208 (90.8%) to be provided to women who seek contraceptives (Table 2 ). Only over one-fifth of the participants (48, 21.0%) stated that they provide emergency contraception and less than half of the participants (108, 47.2%). responded that they supplied implants. Only 25(10.9%) of the participants replied that their health respective facilities offered Option 5 methods, 21 participants (9.2%) said that they offered alternative FP methods (Table 2 ). These results suggest that although most facilities ensured access to common FP methods, advanced or less frequently used methods such as implants, emergency contraception, and Option 5 were not consistently available. Table 2 The availability of FP resources and methods in public health facilities of Hawassa city, Sidama Region, 2025 (N = 229) Variable Category Frequency (n) Percent (%) Staff trained in FP services Yes 228 99.6 No 1 0.4 FP checklist or job aid available Yes 228 99.6 No 1 0.4 FP guidelines available at SDP Yes 229 100.0 Direct supervision visits conducted Yes 228 99.6 No 1 0.4 Use of logistic form in the facility Yes 229 100.0 Oral contraceptives provided Yes 229 100.0 Injectables provided Yes 216 94.3 No 13 5.7 Implants provided Yes 108 47.2 No 121 52.8 IUCDs provided Yes 218 95.2 No 11 4.8 LAM Yes 25 10.9 No 204 89.1 Condoms provided Yes 208 90.8 No 21 9.2 EC provided Yes 48 21.0 No 181 79.0 Other FP methods provided Yes 21 9.2 No 208 90.8 *HF: Health Facility; LAM: Lactational Amenorrhea Method; EC: Emergency contraception; IUCDs: intrauterine contraceptive devices; SDP: Service Delivery Point; FP: Family planning Stock-Out Patterns of FP Commodities The incidence, kind, and length of contraceptive stock-outs were evaluated in this study. While 83 (36.7%) [95% CI: (30.1%, 42.5%)] reported weekly stock-outs, 21 (9.2%) reported monthly shortages, and 16 (7.0%) of respondents said their health facilities experience shortages every three months, nearly half of the respondents (106 (46.7%)) said that stock-outs occur infrequently. Only one health facility (0.4%) said that stock-outs had never happened. Implanon implants were the most commonly reported out-of-stock products among FP goods, according to the majority of respondents (173 (76.4%)), followed by other generic implants (23 (10.0%)) and less common implant kinds (14 (6.1%)). Infrequent reports of supply shortages were found for intrauterine contraceptive devices (IUCDs), oral contraceptives, condoms, and other FP methods (Table 3 ). Table 3 The stock-out patterns of FP commodities in Public Health Facilities of Hawassa City, Sidama Region, Ethiopia (N = 229) Variable Category Frequency Percent (%) Provision of EC Yes 45 19.9 No 181 80.1 Provision of other FP methods Yes 18 8.0 No 208 92.0 Stock-out frequency Weekly 82 36.3 Rarely 107 47.3 Monthly 20 8.8 Every 3 months 16 7.1 Never 1 0.4 Most frequently out of stock method Implanon 173 76.5 Other implants 37 16.4 Condoms 6 2.7 IUD 1 0.4 Oral contraceptives 1 0.4 In terms of the average duration of stock-outs, the majority of facilities (58.5%) reported stock-outs lasting 2–4 weeks. Shorter durations of < 1 week were reported by 25.8% of facilities, 1–2 weeks by 6.6%, and durations longer than 1 month by 9.2% (Fig. 3 ). These findings suggested that contraceptive stock-outs are common, primarily affect implant methods, and typically last between 2 and 4 weeks, highlighting the need for strengthened supply chain management (Fig. 3 ). Observed Consequences of FP Stock-Outs of Respondents A total of 229 respondents (health professionals) were included in this assessment of FP stock-outs in the study area (selected health facilities). The majority of respondents 178(77.4%) reported dissatisfaction as a consequence of stock-outs, followed by combinations of dissatisfaction with interruption 13(5.8%), unintended pregnancies 4(1.8%), and unmet need 2 (0.9%) (Table 4 ). Interruption alone was reported by 38(16.4%) of respondents, while reduced trust in the service was minimal 2(0.9%). When individual outcomes were considered, 7.5% of clients experienced unmet need, 6.6% reported unintended pregnancies, 94.7% reported dissatisfaction, 16.4% experienced interruption, and 0.9% reported reduced trust due to stock-outs (Table 4 ). In reaction to stock-outs, 61.9% of customers occasionally returned to a facility when their preferred FP method was unavailable, 35.8% did so consistently, and 2.2% did not. Due to stock-outs, just 2.6% of respondents stated that clients shifted to less popular FP methods, such as intrauterine contraceptive devices (IUCD) (0.9%) and condoms (1.2%). Most the respondents reported client dissatisfaction as the leading consequence of contraceptive stock-outs 217 (94.7%)). Service interruptions were reported by 38 (16.4%) of respondents, followed by unmet need (17 (7.5%)) and unintended pregnancies (15 (6.6%)). A small proportion of respondents (2 (0.9%)) mentioned reduced trust in health facilities. These findings suggest that family planning stock-outs directly undermine client satisfaction, disrupt continuity of care, and contribute to unmet contraceptive needs. The results showed that FP commodity stock-outs in the research area's public health facilities had a number of negative effects. Service interruption (38 (16.4%)), unmet need (17 (7.5%), unplanned pregnancies (15 (6.6%)), and decreased trust in the health system (2 (0.9%) were the next most prevalent outcomes of stock-outs, according to the majority of respondents (217 (94.7%)). Health professionals also talked about how clients behaved during stock-outs. Following notification of stock-outs, the majority of clients occasionally returned to the facilities (142, or 61.9%), 82 (or 35.8%) did so regularly, and only 5 (2.2%) did not. Six (2.6%) of respondents reported switching to less preferred techniques, making it rare (Table 4 ). The most commonly mentioned alternatives were condoms and IUCDs. To deal with stock-outs, health facilities used a variety of coping strategies. Using other ways was the most popular option (207, 91.6%), followed by referring clients to other facilities (31, 13.5%) and borrowing goods from nearby facilities (21, 9.2%). Only a small percentage of facilities (1.3%) reported doing nothing. According to Table 4 , the primary reasons for stock-outs were budgetary restrictions 11 (4.9%), strong demand 10 (4.5%), inadequate inventory management 26 (11.2%), and supply delays 223 (97.3%). These results underline systemic issues in supply chain management by showing that FP stock-outs not only have a detrimental impact on client satisfaction and continuity of care, but also necessitate flexible approaches from facilities to continue providing services. Table 4 The consequences, client behaviors, and facility responses to FP commodity stock-outs in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia, 2025 (N = 229) Variable Category Frequency (n) Percent (%) Observed consequences of FP stock-outs Dissatisfaction 214 94.7 Interruption 37 16.4 Unintended pregnancies 15 6.6 Unmet need 17 7.5 Reduced trust 2 0.9 Other 0 0.0 Client return when told FP is out of stock No 5 2.2 Sometimes 140 61.9 Yes 81 35.8 Switched to less preferred methods No 220 97.3 Yes 6 2.6 If switched, methods used Condom 4 1.8 IUCD 2 0.9 Measures taken during stock-outs Use alternative methods 210 91.7 Referral 31 13.5 Borrow from nearby 21 9.2 No action 3 1.3 Other 3 1.3 Causes of stock-outs Supply delay 220 97.3 Poor inventory 25 11.2 Budget issue 11 4.9 High demand 10 4.5 Other 0 0.0 Condition of Stock-Outs To investigate the effects of FP stock-outs in the health facilities selected for the study, a descriptive analysis was carried out. According to data gathered from 94.8% of the respondents, client dissatisfaction was the most commonly stated effect. Unplanned pregnancies were acknowledged by 6.6% of respondents (Table 5 ). Unmet demand was indicated by 7.4% of respondents, and 17.5% of participants experienced interruption of FP services. Only 1.3% of respondents reported having less trust on the health facility, making it an uncommon occurrence. In terms of client’s behavior, 62.0% of respondents said that clients occasionally returned when an FP method was out of stock, 35.8% said that clients did return, and just 2.2% said that clients did not return. According to certain participants' (2.6%), switching to less preferred FP methods because of stock-outs were rare and only happened in a small number of health facilities (Table 5 ). Overall, our results show that the primary effect of FP stock-outs is client unhappiness, which may have a detrimental impact on client trust and service utilization. Even though unplanned pregnancies and unmet demand are still uncommon, these results highlight how crucial it is to guarantee a steady supply of FP consumables. The findings point to the necessity of focused interventions to enhance service continuity and fortify supply chain management, especially in establishments that frequently experience stock-outs (Table 5 ). Table 5 The observed consequences of FP stock-outs in Public Health Facilities of Hawassa City, Sidama Region, Ethiopia (N = 229) Variable Category Frequency (n) Percent (%) Dissatisfaction Yes 217 94.8 No 12 5.2 Interruption of services Yes 40 17.5 No 189 82.5 Unintended pregnancies Yes 15 6.6 No 214 93.4 Unmet need Yes 17 7.4 No 212 92.6 Reduced trust Yes 3 1.3 No 226 98.7 Other Consequences Yes 0 0.0 No 229 100.0 Client return when FP out of stock Yes 82 35.8 Sometimes 142 62.0 No 5 2.2 Switch to less preferred methods Yes 6 2.6 No 223 97.4 Coping Mechanisms during Contraceptive Stock-Outs The response of public health institutions to contraceptive stock-outs was investigated by a descriptive study. In order to lessen stock-outs, the majority of participants (91.7%) stated that they used alternative techniques. 9.6% of reported borrowing from neighboring facilities, while 13.5% reported referring to other facilities. Just a small percentage of respondents (1.3%) reported doing nothing or taking vague actions (Fig. 4 ). During stock-outs, nearly all health facilities (97.4%) did not implement the practice of switching to less popular ways. When the desired FP method was not available, only a small percentage of facilities reported utilizing IUCD (0.9%) or condoms (1.7%) as interim substitutes (Fig. 4 ). Overall, these results imply that the majority of facilities actively handle stock-outs by borrowing, referring, or using other strategies, with little dependence on customers switching to less popular ones. These steps reduce the likelihood of service interruptions, client discontent, and unmet demand while preserving the continuity of contraceptive treatment. Health Facilities Observation Data were collected from Governmental hospitals and Health centers of Hawassa city using observation check list under the following thematic four areas. Inventory Management Practices Observation of inventory management practices across governmental hospitals and health centers in Hawassa city revealed varying adherence to standard contraceptive logistics procedures. All facilities (100%) updated contraceptive stock records within the past 30 days, had LMIS tools (bin cards, stock cards, and report forms) available and properly used, and maintained consistency between stock records and physical counts. However, only one facility (20%) submitted requisition forms on time according to the standard schedule, while the majority (80%) did not. Expired contraceptives were identified in one facility (20%), whereas four facilities (80%) had none. Similarly, stock-outs of contraceptives in the past three months were reported in one facility (20%). Moreover, only one facility (20%) arranged products according to the First-Expiry-First Out (FEFO) principle, while most (80%) did not, highlighting significant gaps in timely requisition and stock management practices (Table 6 ). Table 6 Inventory management practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N = 5) Variable Category Number of Health facility (n) Percent (%) Are contraceptive stock records updated regularly (within past 30 days)? Yes 5 100 No 0 0 Are LMIS tools (e.g., bin cards, stock cards, report forms) available and used properly? Yes 5 100 No 0 0 Is the quantity of each contraceptive item recorded on bin cards matching physical count? Yes 5 100 No 0 0 Are contraceptive requisition forms submitted on time (as per standard schedule)? Yes 1 20 No 4 80 Are there any expired contraceptive products on the shelf? Yes 1 20 No 4 80 Is there a record of stock-out for any contraceptive method in the past 3 months? Yes 1 20 No 4 80 Are products arranged according to FEFO principle? Yes 1 20 No 4 80 Bin Cards and Stock Cards Assessment of bin card and stock card practices in public health facilities of Hawassa city revealed notable inconsistencies. Only one facility (20%) had a bin card available for each contraceptive product, while the majority (80%) did not. Likewise, only one facility (20%) had updated bin cards with the most recent stock transactions. Physical counts matched bin card balances in two facilities (40%), whereas discrepancies were observed in three facilities (60%). Stock cards were used for contraceptive inventory tracking in two facilities (40%), but not in the remaining three (60%). Encouragingly, all the five health facilities (100%) investigated or documented discrepancies between physical counts and recorded balances, indicating a level of accountability despite gaps in routine recording and updating of bin and stock cards (Table 7 ) Table 7 Bin card and stock card practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N = 5) Variable Category N o . of Health facility (n) Percent (%) Is a bin card available for each contraceptive product? Yes 1 100 No 4 80 Is the bin card updated with the latest stock transaction? Yes 1 20 No 4 80 Is the physical count equal to the balance on the bin card? Yes 2 40 No 3 60 Are stock cards used for contraceptive inventory tracking? Yes 2 40 No 3 60 Are discrepancies between physical count and record investigated or documented? Yes 5 100 No 0 0 Storage Conditions (Based on National Guidelines) Observation of storage conditions of contraceptives in public health facilities of Hawassa city revealed the existence of both strengths and gaps relative to national standards. Only one facility (20%) stored contraceptives in a clean, dry, and well-ventilated room, while most facilities (80%) did not meet this requirement (Table 8 ). Similarly, just one facility (20%) reported being free from rodents, insects, or pests. On the positive side, all facilities (100%) ensured that contraceptives were protected from direct sunlight and humidity, stored products on shelves at least 10 cm above the ground, and had functioning thermometers and refrigerators for temperature-sensitive products. Adequate and consistent power supply was reported in all facilities (100%), and storage rooms were locked with access limited to authorized staff. However, only one facility (20%) properly stacked cartons and boxes, while the majority (80%) had unstable or improper stacking, which poses potential risks for product safety (Table 8 ). Table 8 The storage conditions for contraceptives in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N = 5) Variable Category Number of Health facility (n) Percent (%) Are contraceptives stored in a clean, dry, and well-ventilated room? Yes 1 20 No 4 80 Is the storage room free from rodents/insects or pests? Yes 1 20 No 4 80 Are contraceptives protected from direct sunlight and humidity? Yes 5 100 No 0 0 Are shelves used to store products off the ground (at least 10 cm)? Yes 5 100 No 0 0 Are cartons and boxes stacked properly (not too high or unstable)? Yes 1 20 No 4 50 Is a thermometer available and functioning in the store? Yes 5 100 No 0 0 Is there a working refrigerator for temperature-sensitive contraceptives? Yes 5 100 No 0 0 Is the power supply adequate and consistent for cold chain management? Yes 5 100 No 0 0 Is the store locked and access limited to authorized personnel only? Yes 5 100 No 0 0 Documentation and Supervision The findings on documentation and supervision practices in Hawassa city public health facilities (selected for the study) indicated strong adherence to national standards. All facilities (100%) had evidence of recent supportive supervision, demonstrated by reports or checklists. Similarly, all facilities (100%) had standard operating procedures (SOPs) or guidelines available for contraceptive storage and management. Moreover, expired products were consistently separated from usable stock and labeled clearly in every facility (100%) (Table 9 ). These results suggest that documentation and supervisory mechanisms are well-established and uniformly implemented across facilities, serving as a positive component of the contraceptive logistics management system. Table 9 The documentation and supervision practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N = 5) Variable Category Number of Health facility (n) Percent (%) Is there evidence of recent supportive supervision (report or checklist)? Yes 5 100.0 No 0 0 Are SOPs or guidelines on contraceptive storage and management available? Yes 5 100 No 0 0 Are expired products separated from usable stock and labeled clearly? Yes 5 100 No 0 0 Associated Factors with Contraceptive Stock-Out A binary logistic regression was conducted to examine factors associated with contraceptive stock-outs in public health facilities of the study area (N = 229). In the contraceptive stock-out level and independent variables using bivariate analysis, variables with a p-value < 0.25 were considered candidate variables for inclusion in the multivariable model to control for potential confounding. Accordingly, years of experience, profession, educational level, and type of health facility were found to be significantly associated with contraceptive stock-out status. Providers with less than 10 years of experience were more than twice as likely to report stock-outs compared to those with 10–20 years of experience (COR = 2.53, 95% CI [1.63, 3.93], p < .05). Likewise, nurses reported stock-outs at a considerably higher rate than midwives (COR = 2.09, 95% CI [1.34, 3.33], p < .05). Compared to respondents with a bachelor's degree or more, those with a diploma were more likely to report stock-outs (COR = 2.07, 95% CI [1.12, 3.84], p < .05). Additionally, health centres were much more likely than hospitals to experience stock-outs (COR = 6.15, 95% CI [2.12, 17.85]), p < .01) (Table 10 ). These results demonstrate that the probability of contraceptive stock-outs is influenced by both institutional-level and individual provider characteristics. Table 10 The factors associated with contraceptive stuck-out status by Bivariate and Multivariable analysis report in public health facilities of Hawassa city, Sidama region, Southern Ethiopia, 2025, (N = 229) Variable Category Stock out level Crude OR (95% CI) Adjusted OR (95% CI) Adequate n 51(22.6%) Inadequate n 178(77.4%) Age (years) < 30 45 (22.0%) 12 (23.1%) 1.06(1.01, 2.10) 0.94 (0.47, 1.87) ≥ 30 160 (78.0%) 40 (76.9%) 1 1. Years of Experience < 10 140 (68.2%) 74 (56.6%) 2.53 (1.63, 3.93)* 1.04 (0.45, 2.43) 10–20 65 (31.8%) 56 (43.4%) 1 1. Sex Female 12 (5.8%) 5.0 (9.6%) 1.45 (0.96, 2.22) 1.52 (0.83, 2.80) Male 193 (94.2%) 47 (90.4%) 1 1 Profession Nurse 100 (48.8%) 28 (53.8%) 2.09 (1.34, 3.33)* 0.82 (0.41, 1.64) Midwife 48 (23.4%) 20 (38.5%) 1.0 1.0 Educational Level Diploma 105 (51.2%) 16 (30.8%) 2.07 (1.12, 3.84)* 0.56 (0.21, 1.51) BSc and above 100 (48.8%) 36 (69.2%) 1 1 Type of HF/SDP Health Center 60 (44.9%) 4.0(1.74%) 6.15 (2.12, 17.85)* 2.44 (1.35, 4.42)** Hospitals 117(55.1) 48(98.26) 1 Associated Factor for Contraceptive Stock-Out: Multivariate Analysis Only the type of health facility remained statistically significant in relation to contraceptive stock-outs after adjusting for professional and socio-demographic characteristics; health centres were more than twice as likely to report stock-outs as hospitals (AOR = 2.44, 95% CI [1.35, 4.42], p < .01). Stock-outs were substantially more likely to occur at facilities lacking trained FP workers (AOR = 3.1, 95% CI: 1.4–6.7, p = 0.002). The probability of stock-outs decreased by 60% when updated stock records were available (AOR = 0.4, 95% CI: 0.2–0.9, p = 0.03). Facilities ≥ 20 km from district pharmacy had 2.5 times higher odds of contraceptive stock-out compared to facilities < 20 km (AOR = 2.5, 95% CI: 1.3–4.8, p = 0.004). In the multivariate model, variables that were significant in the bivariate analysis - like years of experience, profession, and educational attainment - lost statistical significance, indicating that facility-level variations may have confused their apparent connections. Overall, the results show that organizational and structural factors, rather than provider-level characteristics, are the main determinants of contraceptive stock-outs; health centres are significantly more likely to experience stock-outs, most likely as a result of systemic issues like poor supply chain management, a lack of logistics resources, and a diminished capacity for procurement. These findings point to the necessity of focused interventions to improve logistics management and supply chain architecture in health centres, guaranteeing fair resource distribution and enhancing service continuity. DISCUSSION This study assessed contraceptive stock-outs and associated factors in public health facilities of Hawassa City, Sidama Region, Ethiopia. Overall, the findings reveal significant challenges in the availability of FP commodities, particularly implants, and highlight critical structural and organizational determinants of stock-outs ( 11 , 27 ). The study participants were predominantly male, 92.6% (212) with a mean age of 35.5 years, reflecting the gender distribution of health providers in urban Ethiopian health facilities. Nurses comprised the majority of respondents, 55.9% (128), followed by midwives 21.0% (48), health officers 16.6% ( 38 ), pharmacists 0.4% ( 1 ), and general practitioners 1.7% ( 4 ). Most participants held a diploma 52.8% (121) or bachelor’s degree 43.7% (100), and nearly all had less than 10 years of experience at their current health facility. Facilities were evenly distributed across primary hospitals, health centers, general hospitals, and referral hospitals, all located within 20 km of the district pharmacy. These results are consistent with earlier research showing that most FP services in urban Ethiopia are provided by mid-level health professionals ( 33 ). The study revealed strong adherence to FP service guidelines and managerial oversight, with nearly all facilities having trained staff 99.6% (225), FP checklists, job aids, and logistic forms. Direct supervision was reported in 99.6% (225) of facilities, indicating supportive monitoring practices. Oral contraceptives, injectables, IUCDs, and condoms were widely available (≥ 90%), while less common methods such as implants 107(47.2%), emergency contraception (EC) 21% (47), LAM, and other FP methods were inconsistently provided. These results corroborate earlier studies in Ethiopia and Sub-Saharan Africa, which report higher availability of short-acting methods than LARC due to logistical and training constraints ( 35 , 36 ). Stock-outs were common, with 36.3% [95% CI: (30.1%, 42.5%)] of participants reporting weekly stock-outs and 46.7% (106) reporting rare occurrences. Implanon implants were the most frequently affected commodities 76.5% (173), followed by other implant types. Shortages of oral contraceptives, IUCDs, and condoms were minimal. The average stock-out duration was 2–4 weeks in 58.5% (132) of facilities, indicating that when stock-outs occur, they are often prolonged enough to disrupt service delivery. These findings align with prior research demonstrating that implants are particularly vulnerable to stock-outs in Ethiopia due to high demand and complex procurement processes ( 33 ). The most frequently reported consequence of FP stock-outs was client dissatisfaction 94.7% (214), followed by service interruption 37(16.4%), unmet need 7.5% ( 17 ), and unintended pregnancies 6.6% ( 15 ). Reduced trust in the facility was rare 0.9% ( 2 ). Most clients returned to the facility despite stock-outs, and switching to less-preferred methods was uncommon 2.6% ( 6 ), suggesting that stock-outs primarily cause dissatisfaction rather than long-term discontinuation. These findings are consistent with prior evidence that stock-outs negatively affect client satisfaction and service utilization ( 33 ), although the low level of method switching contrasts with other studies where stock-outs led to higher substitution rates ( 34 ). Facilities actively mitigated stock-outs through alternative methods 207(91.7%), referrals 31(13.5%), and borrowing from nearby facilities 21(9.2%). Minimal reliance on switching clients to less-preferred methods indicates a client-centered approach in service continuity. These adaptive measures align with international guidelines for managing stock-outs, emphasizing flexible supply chains and inter-facility collaboration ( 35 ). While all facilities kept up-to-date stock records and LMIS tools, observational data showed that there were notable discrepancies in storage conditions, appropriate stacking (FEFO principle), and requisition scheduling. Just forty-five (20%) of the facilities followed the correct stacking and timely filing of requisitions, while forty-five (20%) kept their commodities in hygienic, pest-free rooms. Product quality may be jeopardised and stock-out risk increased by inconsistent adherence to inventory and storage procedures. Other Ethiopian studies have documented similar shortcomings, highlighting the necessity of improved logistics management at the facility level ( 33 , 34 ). Bivariate analysis revealed a number of factors such as facility type, years of experience, provider occupation, and educational level that are linked to contraceptive stock-outs. Only structural components, however, continued to be significant following multivariate adjustment. New stock records decreased the likelihood of stock-outs (AOR = 0.4, 95% CI [0.2–0.9]), facilities located ≥ 20 km from the district pharmacy had higher odds (AOR = 2.5, 95% CI [1.3–4.8]), health centers were more than twice as likely to report stock-outs than hospitals (AOR = 2.44, 95% CI [1.35–4.42]), and facilities without trained FP staff were at higher risk (AOR = 3.1, 95% CI [1.4–6.7]). These results highlight the fact that organisational and systemic issues, not the personal traits of individual providers, are the main causes of stock-outs ( 35 , 36 ). - Conclusion and Recommendation Conclusion Contraceptive stock-outs remain a significant challenge in public health facilities of the study area, with implants being the most affected method. The study found that 36.3% [95% CI: (30.1%, 42.5%)] of facilities experienced weekly stock-outs, while 106 (46.7%) reported rare occurrences. The average duration of stock-outs was 132 (58.5%) facilities for 2–4 weeks, highlighting that these interruptions are often prolonged and can disrupt service delivery. While widely used methods such as oral contraceptives, injectables, IUCDs, and condoms were generally available, less commonly used methods, including implants 67 (29.7%), emergency contraception 30 (13.3%), and Option 5 (22 or 9.7%), were inconsistently provided, limiting client choice and access to long-acting reversible contraceptives (LARC). Structural and organizational factors were the primary determinants of stock-outs. Health centers were more than twice as likely to experience stock-outs compared to hospitals (AOR = 2.44, 95% CI [1.35–4.42]). Facilities located ≥ 20 km from the district pharmacy had higher odds of stock-outs (AOR = 2.5, 95% CI [1.3–4.8]), and facilities without trained FP staff were at higher risk (AOR = 3.1, 95% CI [1.4–6.7]). Conversely, proper management of updated stock records significantly reduced stock-out likelihood (AOR = 0.4, 95% CI [0.2–0.9]). Recommendations Based on the findings of this study, strengthening supply chain management is essential to reduce the frequency and duration of contraceptive stock-outs, particularly for high-demand methods such as Implanon. Health facilities should implement timely requisition and delivery mechanisms, ensure adherence to the FEFO principle, and maintain proper stock stacking to prevent wastage and ensure the availability of all FP methods. Developing contingency plans, including inter-facility borrowing and referral systems, is also crucial, especially for facilities located farther than 20 km from district pharmacies, to minimize supply delays and ensure uninterrupted service delivery. At the facility level, targeted interventions are necessary, particularly for health centers, which were found to have a higher risk of stock-outs compared to hospitals. Improving storage conditions—ensuring clean, ventilated, and pest-free environments—is critical to maintaining the quality and safety of contraceptive commodities. Periodic audits and regular supervision using checklists and logistic forms can help detect deficiencies early and maintain continuous availability of FP methods. Implementing these recommendations will not only enhance service quality and client satisfaction but also provide baseline data and guidance for future research and policy planning on contraceptive stock-outs in Hawassa City and similar settings. Declarations Acknowledgement WZ duly acknowledges Pharma College, Hawassa Campus. Author Contributions WZ conducted the research and analyzed data. LA supervised the research and prepared the manuscript for publication. Both authors reviewed the manuscript FUNDING There was no funding received for the research Data Availability All data generated and analyzed are included in this research article. For further request, contact the corresponding author. Declarations Ethical approval and consent to participate Ethical approval was obtained from Institutional Research Ethics Review Committee of Pharma College, Hawassa , Ethiopia ( Ref. No.: IRERC 146/205) Consent to participate declaration Informed verbal consent was sought from all participants, and confidentiality was maintained throughout the study by using unique codes instead of names other information revealing their identities. They were informed of their right to withdraw from the study at any time without any consequences. Consent for publication We all authors have read and checked the manuscript for its publication. Competing interests There is no competing interest with any other research group. Clinical Trial number ‘Clinical trial number: not applicable.’ References Helena KK, Kristina GD. Prevention of unintended pregnancy and use of contraception -important factors for preconception care. Ups J Med Sci. 2016,121(4):252–255. Contraception. https://www.who.int/health-topics/contraception#tab=tab_1 (Downloaded on 20 October,2025) Megan LK, Ragnar MA. Contraception and beyond: the health benefits of services provided at family planning centers, 2013. https://www.guttmacher.org/sites/default/files/pdfs/pubs/health-benefits.pdf (Downloaded on 10 September,2025) Kathya LC, Graciela CP, Ana M, Gabriela P, Diva ML, Ivan C. Sexual and reproductive rights for contraception in Bolivia, Colombia and Uruguay in the framework of human rights Rev Panam Salud Publica. 2017;41: e140. Reproductive rights are human rights a handbook for national human rights institutions. https://www.ohchr.org/sites/default/files/Documents/Publications/NHRIHandbook.pdf Women’s and girls’ reproductive choices must be respected, UN experts. https://www.ohchr.org/en/statements-and-speeches/2022/09/womens-and-girls-reproductive-choices-must-be-respected-un-experts (12 September 2025) Pierre M, Alain KK, Philip A, Peter G, Georges G, Funmilola O, Elizabeth O, Sodani PR , Mary T, Pierre A, Amy T, Scott R. Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption. Health Policy Plan. 2021, 17;36(3):273-287. Grindlay K., Turyakira E, Kyamwanga IT, Nickerson A, Blanchard K. The human face of contraceptive stock-outs: a qualitative study in Uganda, 2016. https://www.rhsupplies.org/uploads/tx_rhscpublications/Uganda_Stockouts_Brief_by_IBIS.pdf (12 November, 2025) Amy MM, Mona B. Family planning and reproductive health supply stockouts: problems and remedies for faith-based health facilities in Africa. Christian J Global Health 2017, p19-29 Kate G, Eleanor T, Imelda TK, Adrianne N, Kelly B. The Experience and impact of contraceptive stockouts among women, providers and policymakers in two districts of Uganda. Int Perspect Sexual Reprod Health. 2016, 42(3):141-150. Ayele H, Abebe G. Determinants of contraceptive stock-outs in public health facilities in Southern Ethiopia: A mixed-methods study. Ethiopian J Health Development. 2023, 37(1), 55-65.. Chukwu E, Abiodun P, Okon M. Contraceptive stock-outs and service disruptions in primary healthcare facilities in Nigeria: A cross-sectional analysis . African J Reprod Health, 2023,27(2), 34-41. . Muhoza P, Koffi AK, Anglewicz P, Gichangi P, Guiella G, Olaolorun F, et al. Modern contraceptive availability and stockouts: A multi-country analysis of trends in supply and consumption. Health Policy Plan. 2021,36(3):273-287. Mukasa B, Ali M, Farron M, Van de Weerdt R.. Contraception supply chain challenges: a review of evidence from low- and middle-income countries. The European J Contraception &Amp; Reproductive Health Care, 2017, 22(5),384-390. Bakali M. Contraception supply chain challenges: a review of evidence from low- and middle-income countries. The European J Contraception Reprod Health Care.2017, 22(51). DOI:10.1080/13625187.2017.1394453 Bearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Global Health . 2020;8(9):e1152–e1161. Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries. Fact Sheet. July 2020. https://www.guttmacher.org/fact-sheet/investing-sexual-and-reproductive-health-low-and-middle-income-countries Vijayan KP, Julieann LN. Unmet family planning need globally: A clarion call for sharpening current research frame works. Open Access J Contracept. 2023; 14:139-147. Zuniga C, Wollum A, Grindlay K, Higgins S, Blanchard K. The impacts of contraceptive stock-outs on users, providers, and facilities: A systematic literature review 2 3. Global Public Health, 2022; 17(1), 83-99 Tumlinson K, Britton LE, Goland E, Chung S, Bullington BW, Williams CR, et al. Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study. BMC Health Serv Res. 2023, 23(1), 74. Iryanyawera MC. Associated factors with stock-out for modern contraceptives in health facilities in Rwanda. Master's thesis, University of Rwanda, 2016. Available at: https://dr.ur.ac.rw/bitstream/handle/123456789/452/Iryanyawera.pdf?sequence=1 Gaby I, Denis K, Tim R. Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia .BMC Public Health . 2020, 20(1):1053 Grindlay K, Turyakira E, Kyamwanga IT, Nickerson A, Blanchard K. The experience and impact of contraceptive stockouts among women, providers and policymakers in two districts of Uganda. Int Perspect Sexual Reprod Health. 2022,42, 141-150 Whidden C, Keita Y, Treleaven, E. et al. Women’s empowerment, intrahousehold influences, and health system design on modern contraceptive use in rural Mali: a multilevel analysis of cross-sectional survey data. Reprod Health. 2021, 18, 55. Orsola T. Violent instability and modern contraception: Evidence from Mali World Development. 2024,177, 106538 Tefera BB, Yihunie W, Bekele A. Integrated pharmaceutical logistics system implementation in chagni primary hospital and injibara general hospital, awi zone, Ethiopia. J Multidiscip Healthc. 2021;14:1673–682 FMoH. Ethiopian Demographic and Health Survey 2019: Key Indicators Report. FMoH [Internet]. 2020;1-49. FMoH-Ethiopia. Health Sector Translaformation Plan II (HSTP II). Ethiop Minist Health. 2021;25:96. CSA, 2007: https://www.ethiopianreview.com/pdf/001/Cen2007_firstdraft The Global programme to enhance reproductive health commodity security [Internet]. 2023. Available from: www.unfpa.org (Accessed 25 August 2025) Sexual & Reproductive Health Commodities: Measuring Prices, Availability & Affordability; Methodology & Data Entry Manual (First Edition).( https://haiweb.org/storage/2017/10/Survey-Methodology-SRHR-3.pdf (Downloaded on 23 Nov, 2025) Measurement Report: Family Planning Trends in Sub-Saharan Africa . FP2030, 2023.[ https://www.fp2030.org] Fekadu GD, Mekonnen HH, Getachew M. LMIS performance for program drugs in East Wollega, Oromia Region. J Pharmaceutical Policy and Practice , 2022;15, DOI:10.1093/heapol/czx134 Zimmerman LA, Bell SO, Li Q, Morzenti A, Anglewicz P, Tsui AO. Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020. Res Rev Healthcare: Open Access J . 2019.6(4), 216-219. Mekonnen WT. Assessing the availability of contraceptives in public health facilities in East Africa: A cross-sectional study. Reproductive Health. 2022, 19(1), 45. World Health Organization. Model list of essential medicines (22nd ed.), 2023 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8613593","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592159079,"identity":"07e78956-2662-4f47-aa12-8398b6293708","order_by":0,"name":"Wosen Zeleke","email":"","orcid":"","institution":"Pharma College","correspondingAuthor":false,"prefix":"","firstName":"Wosen","middleName":"","lastName":"Zeleke","suffix":""},{"id":592159080,"identity":"170d14a1-5ff9-490d-b24a-5b8fd77408ef","order_by":1,"name":"Legesse Adane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYFCCBCAugLI/ADEbO1FaDCBMxhkgLcykaGHmAZMENPC3Jz978MHAxq6f//jDxza/tsnzMTMwfviYg1uLxJln5oYzDNKSZ87IMTbO7btt2MbMwCw5cxsea24kmEnzGBxONrjBwyad23ObEaiFjZkXjxb5G+nfpP8Y/E+2P3/8+W/Lntv2BLUY3Mgxk2YwOGBnwJBgxszw43YiQS2GZ96USfYYJCdI3MgxluxtuJ3cxszYjNcvcsfTt0n8qLCz5+8//vDDjz+3bee3Nx/88BGf96EgsQFEMraByQbC6oHAHkL9IUrxKBgFo2AUjDAAAE8rUJNokbVQAAAAAElFTkSuQmCC","orcid":"","institution":"Pharma College","correspondingAuthor":true,"prefix":"","firstName":"Legesse","middleName":"","lastName":"Adane","suffix":""}],"badges":[],"createdAt":"2026-01-15 21:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8613593/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8613593/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102982104,"identity":"01e694b3-d2f8-47b5-8c11-550f7cf5f6dd","added_by":"auto","created_at":"2026-02-19 09:12:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":194143,"visible":true,"origin":"","legend":"\u003cp\u003eThe schematic representation of sampling procedure used in the study.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8613593/v1/f3f83eb0658414cbdbe19bec.png"},{"id":102982093,"identity":"602494a0-3f4e-452d-9d66-6946aefcd494","added_by":"auto","created_at":"2026-02-19 09:12:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":78724,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3\u003c/strong\u003e. The average duration of family planning stock-outs in Public Health facilities, Hawassa City, Sidama Region, Ethiopia, 2025 (N = 229)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8613593/v1/8566b4207f462fab701da5ea.png"},{"id":102982077,"identity":"2f56e5a3-1b10-4896-ae3d-6f89de8b1e6f","added_by":"auto","created_at":"2026-02-19 09:12:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":100605,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4: \u003c/strong\u003eThe\u003cstrong\u003e \u003c/strong\u003emeasures taken during contraceptive stock-outs in Public Health Facilities of Hawassa City, Sidama Region, Ethiopia (N = 229)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8613593/v1/8cbb97ed33f95a9cd7fd8f1f.png"},{"id":107397847,"identity":"8b88dd0f-9797-459d-8adc-d982cda3e778","added_by":"auto","created_at":"2026-04-21 06:57:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1520843,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8613593/v1/d12d7b5d-50ac-4ac8-96fd-ec71523d61f2.pdf"},{"id":102982029,"identity":"4ca46b48-c123-4437-8538-1c576f5fbd45","added_by":"auto","created_at":"2026-02-19 09:12:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":55725,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXES.docx","url":"https://assets-eu.researchsquare.com/files/rs-8613593/v1/9a1e12d5a43b738eb9a80382.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Contraceptive Stock-Out and Its Associated Factors in Public Health Facilities of Hawassa City, Southern Ethiopia: A Cross Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWomen in reproductive ages frequently utilize contraceptives in the modern world. Using contraceptives has many advantages. These include Family Planning (FP), preventing and reducing unintended pregnancies and abortions, promoting maternal health behaviors, lowering pregnancy-related morbidities and mortality, and improving birth outcomes (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It also enables women to exercise their rights of reproductive (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). By encouraging longer education, fewer pregnancies, a later and healthier childbearing age, and greater options for income-producing activities, reports also demonstrated that the use of contraceptives gives adults the chance to live meaningful lives (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, FP has several challenges including issues with supply and management of contraceptive procurement, stock-outs of contraceptives, and lack of access to health facilities (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong these issues, the global shortage of contraceptives is a major problem, particularly in nations with low incomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). When one or more contraceptive choices are not available in a medical facility that regularly offers that technique or that is required by policy to offer that method, it is known as a contraceptive stock out (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The absence of one or more FP techniques at service delivery locations is another definition of it. Unplanned pregnancies, higher rates of morbidity and mortality of mothers and children, and increased strain on these regions' public health systems are all consequences of frequent stock-outs of FP commodities (contraceptives) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to reports, the issue of contraceptive stock outs is a major concern worldwide, especially in low- and middle-income countries (LMICs) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). It is a serious concern of Sub-Saharan Africa (SSA) regions of the world. For example, it has been estimated that 218\u0026nbsp;million women between the ages (15\u0026ndash;49 years of age) do not have access to contemporary forms of contraception. Supply chain failures like transportation delays, inefficient procurement, and poor inventory management are among the primary causes; other factors include inadequate forecasting, limited funding, poor logistics data, inadequate human resources, lack of access, and weak logistics systems (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). As a result, the majority of women (57%) in Southern Asia and SSA experienced unwanted pregnancies, which can result in unintended births, unsafe abortions where access to high-quality services is prohibited by law, maternal deaths, and the loss of years of healthy life (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to a Nigerian study, inconsistent deliveries caused stock-outs in more than 30% of basic health centres (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). According to a Kenyan study, women have significant challenges when it comes to contraceptive stock outs. Stock-outs were significant obstacles for women in the nation to obtain their preferred form of contraception and a cause for switching to less preferred methods. Health, autonomy, and the capacity to avoid unplanned pregnancy were all directly impacted by this. Issues in the supply chain, such as ineffective planning, acquiring, and distributing family planning supplies, have been connected to causes of contraceptive stock-outs (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Similar explanations were offered for Rwanda's current issues with contraceptive stock outs (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA qualitative study was conducted in Uganda. The study involved users/clients and providers, and the results showed that (a) women are accustomed to stock-outs and frequently turn to other providers, often switching to another less effective method; (b) stock-outs lead to negative outcomes for women, such as unintended pregnancy, stress, domestic conflict, and increased overall contraceptive costs; and (c) stock-outs also cause providers to face emotional distress, demoralization, blame, declining skills, and decreased demand for their services. The study on the experience and impact of contraceptive stock-outs also showed that that stock-outs were common and prevalent (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similar study conducted in Mali showed stock out is a problem of in 46% health facilities (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Ethiopian government is committed to enhancing and promoting the reproductive health of men, women, and youth (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). With a reported rise from 6% in 2000 to 41% in 2019, the nation has achieved significant progress in raising contraceptive prevalence rates (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Nevertheless, contraceptive stock-outs continue to be a significant problem in spite of these developments. According to a survey conducted in Southern Ethiopia, over 30% of medical facilities encountered contraceptive stock-outs at least once a year. In addition to influencing personal decisions, this supply irregularity compromises the efficacy of national FP initiatives (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, people may not be able to get their desired method just because it is not available, even if they can pay it and have access to a health institution where contraceptives are regularly supplied (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe purpose of this study is to investigate how common stock-outs of reproductive health supplies, such as contraception, are in Hawassa, Southern Ethiopia. The study's findings would (a) demonstrate the frequency of contraceptive stock-outs in public health facilities. (b) provide health facility administrators with baseline data to develop quality care improvement projects, modify staff in-service training, guide local policy changes, and improve supply chain management. (c) help health workers be vigilant about preventing contraceptive stock-outs that disrupt the provision of high-quality services; and (d) serve as a guide for other researchers who wish to conduct similar studies in other locations (health facilities) with a sizable sample size and in various study settings.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area and Period\u003c/h2\u003e \u003cp\u003eThe study was carried out at Hawassa City, Sidama National Regional State, which is situated 275 kilometers south of Addis Ababa, Ethiopia. According to Central Statistical Agency (CSA, 2007), the city's total population was expected to be 506,467; 51.2% of these were female, while the remaining were male (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The city has ten public health centers with their own pharmacies and medical supply stores, as well as five government hospitals (two general hospitals, two primary hospitals, and one specialty teaching and referral hospital). This study was conducted in selected health facilities of Hawassa city from June 1\u0026ndash;30, 2025.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA facility-based cross-sectional study was conducted.\u003c/p\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eSource Population\u003c/b\u003e: All public Health institutions in the Hawassa city and their respective staffs\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Population\u003c/strong\u003e \u003cp\u003eRandomly selected staffs who are working at MCH, store and dispensary of selected health facilities of Hawassa city.\u003c/p\u003e \u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eInclusion and Exclusion Criteria\u003c/b\u003e:\u003c/div\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003estaffs who work at MCH, store and dispensary of selected health facilities during the study period.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion Criteria\u003c/strong\u003e \u003cp\u003eThose staffs who are not voluntary to participate in the study.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eSample Size and Sampling Technique\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined by using a single population proportion formula with a 95% confidence interval, a 5% margin of error, and adding 5% for the non-respondent rate. By using the proportion of 50% the sample size was calculated as follows.\u003c/p\u003e \u003cp\u003e\u003cimg 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\" width=\"695\" height=\"82\"\u003e\u003c/p\u003e\u003cp\u003eThen since the study population is \u0026lt;\u0026thinsp;10,000 (500 health care providers found in the selected hospitals and health centers), the correction formula was used as follows:\u003c/p\u003e \u003cp\u003enf\u0026thinsp;=\u0026thinsp;ni /1\u0026thinsp;+\u0026thinsp;ni /\u0026#119873;\u003c/p\u003e \u003cp\u003eSample size= \u0026#119899;f\u0026thinsp;=\u0026thinsp;ni/(1\u0026thinsp;+\u0026thinsp;ni/N)\u0026thinsp;=\u0026thinsp;385/(1\u0026thinsp;+\u0026thinsp;500/384)\u0026thinsp;=\u0026thinsp;217.514\u0026thinsp;~\u0026thinsp;218\u003c/p\u003e \u003cp\u003e(Where N\u0026thinsp;=\u0026thinsp;total number of nurses in randomly selected hospitals and health centers [N\u0026thinsp;=\u0026thinsp;500]\u003c/p\u003e \u003cp\u003eBy adding 5% non-response rate (i.e. 0.05*218\u0026thinsp;=\u0026thinsp;~\u0026thinsp;11) the minimal representative sample size, nf\u0026thinsp;=\u0026thinsp;229. Therefore, the final sample size was 229.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling Technique\u003c/h3\u003e\n\u003cp\u003eThree hospitals out of five government hospitals and four health centers out of ten were chosen using a straightforward random sampling technique. Covenant approaches were used to ask the health professionals working at Mother Children Health (MCH), drug stores, and pharmacies. To choose participants, each health facility and its departments were given a proportionate share based on their size (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \n\u003ch3\u003eData Collection Procedure and Instrument\u003c/h3\u003e\n\u003cp\u003eData were collected by trained 5 BSc holder midwives who have experience with reproductive health services. Structured questionnaires were used (\u003cb\u003eAnnex 1\u003c/b\u003e) to collect data from the participants. The data collectors administered the questionnaires (to the participants) in private settings within the health facilities to ensure confidentiality and encourage honest responses. In order to assess bin cards and inventory management practices of each health facility, data collectors reviewed records of stores and dispensary of the selected health facilities. A supervisor was monitoring the data collection process to ensure data quality and consistency.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Methods and Instruments\u003c/h2\u003e \u003cp\u003eData was collected using structured questionnaires, in-depth interviews, and facility family planning record reviews. Data was collected using direct interviews using the Kobo tool and the instrument was modified and adapted from several investigations and has three parts: socio-demographic issues, pattern of contraceptive stock out, and the consequence of stock out. Data was collected and supervised by BSc nurses who work at family planning with research experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eDependent Variables\u003c/h2\u003e \u003cp\u003eContraceptive stock-out status (Adequate or Inadequate)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIndependent Variable\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSocio-demographic characteristics of the respondents\u003c/b\u003e: Age, gender, address, marital status, profession, income etc\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactors related with health facility\u003c/b\u003e: Level/Type of health facility: Primary (health center), secondary (district hospital) or tertiary (referral hospital), health facility location( rural or urban), distance between the health facility and the district pharmacy, management of the HF (referred to as public or faith-based/NGO facilities\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactors related with service providers\u003c/b\u003e: Availability of trained staff in health facility (Yes or No), frequency of supervision made at the health facility in FP program, availability of Monitoring and Evaluation and ICT tools: \u003cb\u003eYes\u003c/b\u003e or \u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInventory Management\u003c/b\u003e: Stock Availability, Supply Chain and Logistics\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOperational\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eDefinitions\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eContraceptive Stock-Out\u003c/b\u003e: The unavailability of one or more modern contraceptive methods (e.g., injectables, implants, oral pills, condoms) in a health facility at the time of visit or data collection, lasting for at least one day (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTraining in Logistics Management\u003c/strong\u003e \u003cp\u003eWhether logistics or pharmacy staff have received formal training on contraceptive commodity management within the last two years (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHuman Resource Adequacy\u003c/strong\u003e \u003cp\u003eThe presence of at least one trained staff responsible for contraceptive logistics and stock management (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eForecasting Accuracy\u003c/strong\u003e \u003cp\u003eThe degree to which a facility accurately estimates its contraceptive needs during the reporting period. Assessed through comparison of estimated vs. actual usage and stock-out records (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStaff Workload\u003c/strong\u003e \u003cp\u003eThe number of family planning clients served per staff per day or week. This can be categorized as high, moderate, or low (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStorage Capacity\u003c/strong\u003e \u003cp\u003e Availability of dedicated, secure, and adequate space for storing contraceptives in compliance with standard guidelines. Measured as \u0026ldquo;adequate\u0026rdquo; or \u0026ldquo;inadequate\u0026rdquo;\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSupervision\u003c/strong\u003e \u003cp\u003eFrequency of supervisory visits from Hawassa-city Health Bureau or Sidama Region health office regarding FP commodity management (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClient Load\u003c/strong\u003e \u003cp\u003eAverage number of FP clients served per month by the facility, based on service records for the last 3\u0026ndash;6 months (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eeLMIS Usage\u003c/strong\u003e \u003cp\u003eThe extent to which a facility uses an electronic Logistics Management Information System for inventory tracking, requisition, and reporting. Measured as \u0026ldquo;\u003cb\u003eYes\u003c/b\u003e\u0026rdquo;, if used regularly for FP commodities (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Control Measures\u003c/h2\u003e \u003cp\u003eTo ensure data quality, training and orientation was given to the data collectors by the principal investigator. In order to achieve a good data quality, the questionnaire was prepared in English \u003cb\u003e(Annex 1)\u003c/b\u003e and translate into Amharic language (\u003cb\u003eAnnex 2\u003c/b\u003e) and then back to English to keep its consistency. Pre-test was conducted at Abela health center on 5% of sample size prior to the actual data collection to see for the quality of the data collection tool and to estimate time needed. The completeness and consistency of questionnaire for each respondent was checked at the time of data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e \u003cp\u003eAfter being coded, gathered, and imported into the Kobo toolbox, the data was transferred to SPSS version 26 for analysis. The data was summarized using descriptive statistics, such as means, frequencies, percentages, and standard deviations (SDs). Factors linked to FP utilization were identified through bivariate analysis and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were added to a multivariable logistic regression model. It was employed to observe the independent impact of independent variables on the outcome variable through the control of confounding variables. 95% confidence intervals (CIs) for odds ratios were used to quantify the degree of connection. The cutoff criterion for testing statistical significance was a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Variables with noteworthy results were presented in tables, graphs, and charts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eEthical Clearance\u003c/h2\u003e \u003cp\u003e Pharma College's Institutional Research Review Committee (IRRC) granted ethical clearance. Support letters were prepared for the hospitals, health centers, and Hawaii City Health Bureau, respectively. All participants gave their verbal informed agreement, and the study was kept anonymous by employing unique codes rather than names, IDs, and phone numbers. The freedom to leave the study at any moment and without penalty was explained to the participants.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristics of Participants\u003c/h2\u003e \u003cp\u003eA total of 229 participants were included in the study and a response rate of 100% was obtained. Most participants were male 212 (92.6%), while females accounted for 17 (7.4%). The mean age of respondents was 35.52 years (SD\u0026thinsp;=\u0026thinsp;4.0). Regarding professional background, nurses constituted the largest group 128 (55.9%), followed by midwives 48 (21.0%), health officers 38 (16.6%), pharmacists 11 (4.8%), and general practitioners 4 (1.7%). Nearly all respondents 214 (93.4%) had less than 10 years of experience in their current health facility. In terms of educational level, 121 (52.8%) participants held diploma, 100 (43.7%) had a bachelor\u0026rsquo;s degree, 7 (3.1%) were medical doctors, and 1 (0.4%) had other qualifications. The participants were from different level health facilities; 65 (28.4%) from primary hospitals, 64 (27.9%) from health centers, 54 (23.6%) from referral hospitals, and 46 (20.1%) from general hospitals (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All facilities were located within 20 km of the district pharmacy as mentioned by the respondents and were situated in urban settings.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe socio-demographic characteristics of the study participants from public health facilities of Hawassa city, Sidama Region, 2025 (N\u0026thinsp;=\u0026thinsp;229)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBSc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eLevel of HF/SDP*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferral Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDistance between the HF \u0026amp; District Pharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*HF: Health facility; SDP: Service Delivery Point\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eFactors Related to Providers, Materials and Tools\u003c/h2\u003e \u003cp\u003eThe responses gathered from the participant of the study showed that most health facilities had the resources needed to provide FP services; almost all facilities had FP-trained staff (228 or 99.6%), and a comparable proportions had FP checklists or job aids available; all participants (229 (100%)) responded that their facilities had FP guidelines and used logistic forms; and the respondents (228 (99.6%)) also mentioned that all the facilities had regular and direct supervision visits, indicating strong support and oversight for FP service delivery (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These results show that resource availability and administrative support for FP services were practically universal in the assessed facilities.\u003c/p\u003e \u003cp\u003eRegarding the provision of the FP method, the survey participants responded that the health facilities where they work have oral contraceptives (229 (100%)), Injectables (216 (94.3%)), IUCDs (218 (95.2%), and condoms (208 (90.8%) to be provided to women who seek contraceptives (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Only over one-fifth of the participants (48, 21.0%) stated that they provide emergency contraception and less than half of the participants (108, 47.2%). responded that they supplied implants. Only 25(10.9%) of the participants replied that their health respective facilities offered Option 5 methods, 21 participants (9.2%) said that they offered alternative FP methods (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These results suggest that although most facilities ensured access to common FP methods, advanced or less frequently used methods such as implants, emergency contraception, and Option 5 were not consistently available.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe availability of FP resources and methods in public health facilities of Hawassa city, Sidama Region, 2025 (N\u0026thinsp;=\u0026thinsp;229)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff trained in FP services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFP checklist or job aid available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFP guidelines available at SDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect supervision visits conducted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of logistic form in the facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral contraceptives provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjectables provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplants provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIUCDs provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondoms provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEC provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther FP methods provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*HF: Health Facility; LAM: Lactational Amenorrhea Method; EC: Emergency contraception; IUCDs: intrauterine contraceptive devices; SDP: Service Delivery Point; FP: Family planning\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStock-Out Patterns of FP Commodities\u003c/h2\u003e \u003cp\u003eThe incidence, kind, and length of contraceptive stock-outs were evaluated in this study. While 83 (36.7%) [95% CI: (30.1%, 42.5%)] reported weekly stock-outs, 21 (9.2%) reported monthly shortages, and 16 (7.0%) of respondents said their health facilities experience shortages every three months, nearly half of the respondents (106 (46.7%)) said that stock-outs occur infrequently. Only one health facility (0.4%) said that stock-outs had never happened. Implanon implants were the most commonly reported out-of-stock products among FP goods, according to the majority of respondents (173 (76.4%)), followed by other generic implants (23 (10.0%)) and less common implant kinds (14 (6.1%)). Infrequent reports of supply shortages were found for intrauterine contraceptive devices (IUCDs), oral contraceptives, condoms, and other FP methods (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe \u003cb\u003estock-out patterns of FP commodities in Public Health Facilities of Hawassa City, Sidama Region, Ethiopia (N\u0026thinsp;=\u0026thinsp;229)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProvision of EC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProvision of other FP methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eStock-out frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMost frequently out of stock method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplanon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther implants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCondoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn terms of the average duration of stock-outs, the majority of facilities (58.5%) reported stock-outs lasting 2\u0026ndash;4 weeks. Shorter durations of \u0026lt;\u0026thinsp;1 week were reported by 25.8% of facilities, 1\u0026ndash;2 weeks by 6.6%, and durations longer than 1 month by 9.2% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These findings suggested that contraceptive stock-outs are common, primarily affect implant methods, and typically last between 2 and 4 weeks, highlighting the need for strengthened supply chain management (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eObserved Consequences of FP Stock-Outs of Respondents\u003c/h2\u003e \u003cp\u003eA total of 229 respondents (health professionals) were included in this assessment of FP stock-outs in the study area (selected health facilities). The majority of respondents 178(77.4%) reported dissatisfaction as a consequence of stock-outs, followed by combinations of dissatisfaction with interruption 13(5.8%), unintended pregnancies 4(1.8%), and unmet need 2 (0.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Interruption alone was reported by 38(16.4%) of respondents, while reduced trust in the service was minimal 2(0.9%). When individual outcomes were considered, 7.5% of clients experienced unmet need, 6.6% reported unintended pregnancies, 94.7% reported dissatisfaction, 16.4% experienced interruption, and 0.9% reported reduced trust due to stock-outs (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In reaction to stock-outs, 61.9% of customers occasionally returned to a facility when their preferred FP method was unavailable, 35.8% did so consistently, and 2.2% did not. Due to stock-outs, just 2.6% of respondents stated that clients shifted to less popular FP methods, such as intrauterine contraceptive devices (IUCD) (0.9%) and condoms (1.2%).\u003c/p\u003e \u003cp\u003eMost the respondents reported client dissatisfaction as the leading consequence of contraceptive stock-outs 217 (94.7%)). Service interruptions were reported by 38 (16.4%) of respondents, followed by unmet need (17 (7.5%)) and unintended pregnancies (15 (6.6%)). A small proportion of respondents (2 (0.9%)) mentioned reduced trust in health facilities. These findings suggest that family planning stock-outs directly undermine client satisfaction, disrupt continuity of care, and contribute to unmet contraceptive needs.\u003c/p\u003e \u003cp\u003eThe results showed that FP commodity stock-outs in the research area's public health facilities had a number of negative effects. Service interruption (38 (16.4%)), unmet need (17 (7.5%), unplanned pregnancies (15 (6.6%)), and decreased trust in the health system (2 (0.9%) were the next most prevalent outcomes of stock-outs, according to the majority of respondents (217 (94.7%)). Health professionals also talked about how clients behaved during stock-outs. Following notification of stock-outs, the majority of clients occasionally returned to the facilities (142, or 61.9%), 82 (or 35.8%) did so regularly, and only 5 (2.2%) did not. Six (2.6%) of respondents reported switching to less preferred techniques, making it rare (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The most commonly mentioned alternatives were condoms and IUCDs.\u003c/p\u003e \u003cp\u003eTo deal with stock-outs, health facilities used a variety of coping strategies. Using other ways was the most popular option (207, 91.6%), followed by referring clients to other facilities (31, 13.5%) and borrowing goods from nearby facilities (21, 9.2%). Only a small percentage of facilities (1.3%) reported doing nothing. According to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the primary reasons for stock-outs were budgetary restrictions 11 (4.9%), strong demand 10 (4.5%), inadequate inventory management 26 (11.2%), and supply delays 223 (97.3%). These results underline systemic issues in supply chain management by showing that FP stock-outs not only have a detrimental impact on client satisfaction and continuity of care, but also necessitate flexible approaches from facilities to continue providing services.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe \u003cb\u003econsequences, client behaviors, and facility responses to FP commodity stock-outs in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia, 2025 (N\u0026thinsp;=\u0026thinsp;229)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eObserved consequences of FP stock-outs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnintended pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmet need\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduced trust\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClient return when told FP is out of stock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwitched to less preferred methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIf switched, methods used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCondom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIUCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMeasures taken during stock-outs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse alternative methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBorrow from nearby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCauses of stock-outs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupply delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor inventory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBudget issue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eCondition of Stock-Outs\u003c/h2\u003e \u003cp\u003eTo investigate the effects of FP stock-outs in the health facilities selected for the study, a descriptive analysis was carried out. According to data gathered from 94.8% of the respondents, client dissatisfaction was the most commonly stated effect. Unplanned pregnancies were acknowledged by 6.6% of respondents (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Unmet demand was indicated by 7.4% of respondents, and 17.5% of participants experienced interruption of FP services. Only 1.3% of respondents reported having less trust on the health facility, making it an uncommon occurrence.\u003c/p\u003e \u003cp\u003eIn terms of client\u0026rsquo;s behavior, 62.0% of respondents said that clients occasionally returned when an FP method was out of stock, 35.8% said that clients did return, and just 2.2% said that clients did not return. According to certain participants' (2.6%), switching to less preferred FP methods because of stock-outs were rare and only happened in a small number of health facilities (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, our results show that the primary effect of FP stock-outs is client unhappiness, which may have a detrimental impact on client trust and service utilization. Even though unplanned pregnancies and unmet demand are still uncommon, these results highlight how crucial it is to guarantee a steady supply of FP consumables. The findings point to the necessity of focused interventions to enhance service continuity and fortify supply chain management, especially in establishments that frequently experience stock-outs (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe \u003cb\u003eobserved consequences of FP stock-outs in Public Health Facilities of Hawassa City, Sidama Region, Ethiopia (N\u0026thinsp;=\u0026thinsp;229)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterruption of services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnintended pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnmet need\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReduced trust\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOther Consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClient return when FP out of stock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwitch to less preferred methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eCoping Mechanisms during Contraceptive Stock-Outs\u003c/h2\u003e \u003cp\u003eThe response of public health institutions to contraceptive stock-outs was investigated by a descriptive study. In order to lessen stock-outs, the majority of participants (91.7%) stated that they used alternative techniques. 9.6% of reported borrowing from neighboring facilities, while 13.5% reported referring to other facilities. Just a small percentage of respondents (1.3%) reported doing nothing or taking vague actions (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDuring stock-outs, nearly all health facilities (97.4%) did not implement the practice of switching to less popular ways. When the desired FP method was not available, only a small percentage of facilities reported utilizing IUCD (0.9%) or condoms (1.7%) as interim substitutes (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Overall, these results imply that the majority of facilities actively handle stock-outs by borrowing, referring, or using other strategies, with little dependence on customers switching to less popular ones. These steps reduce the likelihood of service interruptions, client discontent, and unmet demand while preserving the continuity of contraceptive treatment.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eHealth Facilities Observation\u003c/h2\u003e \u003cp\u003eData were collected from Governmental hospitals and Health centers of Hawassa city using observation check list under the following thematic four areas.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eInventory Management Practices\u003c/h2\u003e \u003cp\u003eObservation of inventory management practices across governmental hospitals and health centers in Hawassa city revealed varying adherence to standard contraceptive logistics procedures. All facilities (100%) updated contraceptive stock records within the past 30 days, had LMIS tools (bin cards, stock cards, and report forms) available and properly used, and maintained consistency between stock records and physical counts. However, only one facility (20%) submitted requisition forms on time according to the standard schedule, while the majority (80%) did not. Expired contraceptives were identified in one facility (20%), whereas four facilities (80%) had none. Similarly, stock-outs of contraceptives in the past three months were reported in one facility (20%). Moreover, only one facility (20%) arranged products according to the First-Expiry-First Out (FEFO) principle, while most (80%) did not, highlighting significant gaps in timely requisition and stock management practices (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInventory management practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Health facility (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre contraceptive stock records updated regularly (within past 30 days)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre LMIS tools (e.g., bin cards, stock cards, report forms) available and used properly?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the quantity of each contraceptive item recorded on bin cards matching physical count?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre contraceptive requisition forms submitted on time (as per standard schedule)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre there any expired contraceptive products on the shelf?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs there a record of stock-out for any contraceptive method in the past 3 months?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre products arranged according to FEFO principle?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eBin Cards and Stock Cards\u003c/h2\u003e \u003cp\u003eAssessment of bin card and stock card practices in public health facilities of Hawassa city revealed notable inconsistencies. Only one facility (20%) had a bin card available for each contraceptive product, while the majority (80%) did not. Likewise, only one facility (20%) had updated bin cards with the most recent stock transactions. Physical counts matched bin card balances in two facilities (40%), whereas discrepancies were observed in three facilities (60%). Stock cards were used for contraceptive inventory tracking in two facilities (40%), but not in the remaining three (60%). Encouragingly, all the five health facilities (100%) investigated or documented discrepancies between physical counts and recorded balances, indicating a level of accountability despite gaps in routine recording and updating of bin and stock cards (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBin card and stock card practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eo\u003c/span\u003e. of Health facility (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs a bin card available for each contraceptive product?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the bin card updated with the latest stock transaction?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the physical count equal to the balance on the bin card?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre stock cards used for contraceptive inventory tracking?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre discrepancies between physical count and record investigated or documented?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eStorage Conditions (Based on National Guidelines)\u003c/h2\u003e \u003cp\u003eObservation of storage conditions of contraceptives in public health facilities of Hawassa city revealed the existence of both strengths and gaps relative to national standards. Only one facility (20%) stored contraceptives in a clean, dry, and well-ventilated room, while most facilities (80%) did not meet this requirement (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Similarly, just one facility (20%) reported being free from rodents, insects, or pests. On the positive side, all facilities (100%) ensured that contraceptives were protected from direct sunlight and humidity, stored products on shelves at least 10 cm above the ground, and had functioning thermometers and refrigerators for temperature-sensitive products. Adequate and consistent power supply was reported in all facilities (100%), and storage rooms were locked with access limited to authorized staff. However, only one facility (20%) properly stacked cartons and boxes, while the majority (80%) had unstable or improper stacking, which poses potential risks for product safety (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe storage conditions for contraceptives in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Health facility (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre contraceptives stored in a clean, dry, and well-ventilated room?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the storage room free from rodents/insects or pests?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre contraceptives protected from direct sunlight and humidity?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre shelves used to store products off the ground (at least 10 cm)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre cartons and boxes stacked properly (not too high or unstable)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs a thermometer available and functioning in the store?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs there a working refrigerator for temperature-sensitive contraceptives?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the power supply adequate and consistent for cold chain management?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs the store locked and access limited to authorized personnel only?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eDocumentation and Supervision\u003c/h2\u003e \u003cp\u003eThe findings on documentation and supervision practices in Hawassa city public health facilities (selected for the study) indicated strong adherence to national standards. All facilities (100%) had evidence of recent supportive supervision, demonstrated by reports or checklists. Similarly, all facilities (100%) had standard operating procedures (SOPs) or guidelines available for contraceptive storage and management. Moreover, expired products were consistently separated from usable stock and labeled clearly in every facility (100%) (Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e). These results suggest that documentation and supervisory mechanisms are well-established and uniformly implemented across facilities, serving as a positive component of the contraceptive logistics management system.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe documentation and supervision practices in Public Health Facilities of Hawassa City, Sidama Region, Southern Ethiopia 2025 (N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Health facility (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs there evidence of recent supportive supervision (report or checklist)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre SOPs or guidelines on contraceptive storage and management available?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAre expired products separated from usable stock and labeled clearly?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssociated Factors with Contraceptive Stock-Out\u003c/h3\u003e\n\u003cp\u003eA binary logistic regression was conducted to examine factors associated with contraceptive stock-outs in public health facilities of the study area (N\u0026thinsp;=\u0026thinsp;229). In the contraceptive stock-out level and independent variables using bivariate analysis, variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were considered candidate variables for inclusion in the multivariable model to control for potential confounding. Accordingly, years of experience, profession, educational level, and type of health facility were found to be significantly associated with contraceptive stock-out status. Providers with less than 10 years of experience were more than twice as likely to report stock-outs compared to those with 10\u0026ndash;20 years of experience (COR\u0026thinsp;=\u0026thinsp;2.53, 95% CI [1.63, 3.93], p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Likewise, nurses reported stock-outs at a considerably higher rate than midwives (COR\u0026thinsp;=\u0026thinsp;2.09, 95% CI [1.34, 3.33], p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Compared to respondents with a bachelor's degree or more, those with a diploma were more likely to report stock-outs (COR\u0026thinsp;=\u0026thinsp;2.07, 95% CI [1.12, 3.84], p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Additionally, health centres were much more likely than hospitals to experience stock-outs (COR\u0026thinsp;=\u0026thinsp;6.15, 95% CI [2.12, 17.85]), p\u0026thinsp;\u0026lt;\u0026thinsp;.01) (Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e). These results demonstrate that the probability of contraceptive stock-outs is influenced by both institutional-level and individual provider characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe factors associated with contraceptive stuck-out status by Bivariate and Multivariable analysis report in public health facilities of Hawassa city, Sidama region, Southern Ethiopia, 2025, (N\u0026thinsp;=\u0026thinsp;229)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eStock out level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdequate n 51(22.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInadequate n 178(77.4%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06(1.01, 2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94 (0.47, 1.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (78.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYears of Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (56.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.53 (1.63, 3.93)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.04 (0.45, 2.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56 (43.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45 (0.96, 2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.52 (0.83, 2.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e193 (94.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47 (90.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.09 (1.34, 3.33)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82 (0.41, 1.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.07 (1.12, 3.84)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56 (0.21, 1.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBSc and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of HF/SDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0(1.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.15 (2.12, 17.85)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.44 (1.35, 4.42)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117(55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48(98.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eAssociated Factor for Contraceptive Stock-Out: Multivariate Analysis\u003c/h2\u003e \u003cp\u003eOnly the type of health facility remained statistically significant in relation to contraceptive stock-outs after adjusting for professional and socio-demographic characteristics; health centres were more than twice as likely to report stock-outs as hospitals (AOR\u0026thinsp;=\u0026thinsp;2.44, 95% CI [1.35, 4.42], p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Stock-outs were substantially more likely to occur at facilities lacking trained FP workers (AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI: 1.4\u0026ndash;6.7, p\u0026thinsp;=\u0026thinsp;0.002). The probability of stock-outs decreased by 60% when updated stock records were available (AOR\u0026thinsp;=\u0026thinsp;0.4, 95% CI: 0.2\u0026ndash;0.9, p\u0026thinsp;=\u0026thinsp;0.03). Facilities\u0026thinsp;\u0026ge;\u0026thinsp;20 km from district pharmacy had 2.5 times higher odds of contraceptive stock-out compared to facilities\u0026thinsp;\u0026lt;\u0026thinsp;20 km (AOR\u0026thinsp;=\u0026thinsp;2.5, 95% CI: 1.3\u0026ndash;4.8, p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e \u003cp\u003eIn the multivariate model, variables that were significant in the bivariate analysis - like years of experience, profession, and educational attainment - lost statistical significance, indicating that facility-level variations may have confused their apparent connections. Overall, the results show that organizational and structural factors, rather than provider-level characteristics, are the main determinants of contraceptive stock-outs; health centres are significantly more likely to experience stock-outs, most likely as a result of systemic issues like poor supply chain management, a lack of logistics resources, and a diminished capacity for procurement. These findings point to the necessity of focused interventions to improve logistics management and supply chain architecture in health centres, guaranteeing fair resource distribution and enhancing service continuity.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study assessed contraceptive stock-outs and associated factors in public health facilities of Hawassa City, Sidama Region, Ethiopia. Overall, the findings reveal significant challenges in the availability of FP commodities, particularly implants, and highlight critical structural and organizational determinants of stock-outs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study participants were predominantly male, 92.6% (212) with a mean age of 35.5 years, reflecting the gender distribution of health providers in urban Ethiopian health facilities. Nurses comprised the majority of respondents, 55.9% (128), followed by midwives 21.0% (48), health officers 16.6% (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), pharmacists 0.4% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), and general practitioners 1.7% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Most participants held a diploma 52.8% (121) or bachelor\u0026rsquo;s degree 43.7% (100), and nearly all had less than 10 years of experience at their current health facility. Facilities were evenly distributed across primary hospitals, health centers, general hospitals, and referral hospitals, all located within 20 km of the district pharmacy. These results are consistent with earlier research showing that most FP services in urban Ethiopia are provided by mid-level health professionals (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The study revealed strong adherence to FP service guidelines and managerial oversight, with nearly all facilities having trained staff 99.6% (225), FP checklists, job aids, and logistic forms. Direct supervision was reported in 99.6% (225) of facilities, indicating supportive monitoring practices. Oral contraceptives, injectables, IUCDs, and condoms were widely available (\u0026ge;\u0026thinsp;90%), while less common methods such as implants 107(47.2%), emergency contraception (EC) 21% (47), LAM, and other FP methods were inconsistently provided. These results corroborate earlier studies in Ethiopia and Sub-Saharan Africa, which report higher availability of short-acting methods than LARC due to logistical and training constraints (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStock-outs were common, with 36.3% [95% CI: (30.1%, 42.5%)] of participants reporting weekly stock-outs and 46.7% (106) reporting rare occurrences. Implanon implants were the most frequently affected commodities 76.5% (173), followed by other implant types. Shortages of oral contraceptives, IUCDs, and condoms were minimal. The average stock-out duration was 2\u0026ndash;4 weeks in 58.5% (132) of facilities, indicating that when stock-outs occur, they are often prolonged enough to disrupt service delivery. These findings align with prior research demonstrating that implants are particularly vulnerable to stock-outs in Ethiopia due to high demand and complex procurement processes (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most frequently reported consequence of FP stock-outs was client dissatisfaction 94.7% (214), followed by service interruption 37(16.4%), unmet need 7.5% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and unintended pregnancies 6.6% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Reduced trust in the facility was rare 0.9% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Most clients returned to the facility despite stock-outs, and switching to less-preferred methods was uncommon 2.6% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), suggesting that stock-outs primarily cause dissatisfaction rather than long-term discontinuation. These findings are consistent with prior evidence that stock-outs negatively affect client satisfaction and service utilization (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), although the low level of method switching contrasts with other studies where stock-outs led to higher substitution rates (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFacilities actively mitigated stock-outs through alternative methods 207(91.7%), referrals 31(13.5%), and borrowing from nearby facilities 21(9.2%). Minimal reliance on switching clients to less-preferred methods indicates a client-centered approach in service continuity. These adaptive measures align with international guidelines for managing stock-outs, emphasizing flexible supply chains and inter-facility collaboration (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile all facilities kept up-to-date stock records and LMIS tools, observational data showed that there were notable discrepancies in storage conditions, appropriate stacking (FEFO principle), and requisition scheduling. Just forty-five (20%) of the facilities followed the correct stacking and timely filing of requisitions, while forty-five (20%) kept their commodities in hygienic, pest-free rooms. Product quality may be jeopardised and stock-out risk increased by inconsistent adherence to inventory and storage procedures. Other Ethiopian studies have documented similar shortcomings, highlighting the necessity of improved logistics management at the facility level (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBivariate analysis revealed a number of factors such as facility type, years of experience, provider occupation, and educational level that are linked to contraceptive stock-outs. Only structural components, however, continued to be significant following multivariate adjustment. New stock records decreased the likelihood of stock-outs (AOR\u0026thinsp;=\u0026thinsp;0.4, 95% CI [0.2\u0026ndash;0.9]), facilities located\u0026thinsp;\u0026ge;\u0026thinsp;20 km from the district pharmacy had higher odds (AOR\u0026thinsp;=\u0026thinsp;2.5, 95% CI [1.3\u0026ndash;4.8]), health centers were more than twice as likely to report stock-outs than hospitals (AOR\u0026thinsp;=\u0026thinsp;2.44, 95% CI [1.35\u0026ndash;4.42]), and facilities without trained FP staff were at higher risk (AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI [1.4\u0026ndash;6.7]). These results highlight the fact that organisational and systemic issues, not the personal traits of individual providers, are the main causes of stock-outs (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). -\u003c/p\u003e "},{"header":"Conclusion and Recommendation","content":"\u003ch3\u003eConclusion\u003c/h3\u003e\n\u003cp\u003eContraceptive stock-outs remain a significant challenge in public health facilities of the study area, with implants being the most affected method. The study found that 36.3% [95% CI: (30.1%, 42.5%)] of facilities experienced weekly stock-outs, while 106 (46.7%) reported rare occurrences. The average duration of stock-outs was 132 (58.5%) facilities for 2\u0026ndash;4 weeks, highlighting that these interruptions are often prolonged and can disrupt service delivery. While widely used methods such as oral contraceptives, injectables, IUCDs, and condoms were generally available, less commonly used methods, including implants 67 (29.7%), emergency contraception 30 (13.3%), and Option 5 (22 or 9.7%), were inconsistently provided, limiting client choice and access to long-acting reversible contraceptives (LARC).\u003c/p\u003e \u003cp\u003eStructural and organizational factors were the primary determinants of stock-outs. Health centers were more than twice as likely to experience stock-outs compared to hospitals (AOR\u0026thinsp;=\u0026thinsp;2.44, 95% CI [1.35\u0026ndash;4.42]). Facilities located\u0026thinsp;\u0026ge;\u0026thinsp;20 km from the district pharmacy had higher odds of stock-outs (AOR\u0026thinsp;=\u0026thinsp;2.5, 95% CI [1.3\u0026ndash;4.8]), and facilities without trained FP staff were at higher risk (AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI [1.4\u0026ndash;6.7]). Conversely, proper management of updated stock records significantly reduced stock-out likelihood (AOR\u0026thinsp;=\u0026thinsp;0.4, 95% CI [0.2\u0026ndash;0.9]).\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eBased on the findings of this study, strengthening supply chain management is essential to reduce the frequency and duration of contraceptive stock-outs, particularly for high-demand methods such as Implanon. Health facilities should implement timely requisition and delivery mechanisms, ensure adherence to the FEFO principle, and maintain proper stock stacking to prevent wastage and ensure the availability of all FP methods. Developing contingency plans, including inter-facility borrowing and referral systems, is also crucial, especially for facilities located farther than 20 km from district pharmacies, to minimize supply delays and ensure uninterrupted service delivery.\u003c/p\u003e \u003cp\u003eAt the facility level, targeted interventions are necessary, particularly for health centers, which were found to have a higher risk of stock-outs compared to hospitals. Improving storage conditions\u0026mdash;ensuring clean, ventilated, and pest-free environments\u0026mdash;is critical to maintaining the quality and safety of contraceptive commodities. Periodic audits and regular supervision using checklists and logistic forms can help detect deficiencies early and maintain continuous availability of FP methods. Implementing these recommendations will not only enhance service quality and client satisfaction but also provide baseline data and guidance for future research and policy planning on contraceptive stock-outs in Hawassa City and similar settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWZ duly acknowledges Pharma College, Hawassa Campus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWZ conducted the research and analyzed data.\u003c/p\u003e\n\u003cp\u003eLA supervised the research and prepared the manuscript for publication.\u003c/p\u003e\n\u003cp\u003eBoth authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding received for the research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed are included in this research article. For further request, contact the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations Ethical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Institutional Research Ethics Review Committee of Pharma College, Hawassa , Ethiopia (\u003cstrong\u003eRef. No.: IRERC 146/205)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed verbal consent was sought from all participants, and confidentiality was maintained throughout the study by using unique codes instead of names other information revealing their identities. They were informed of their right to withdraw from the study at any time without any consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe all authors have read and checked the manuscript for its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no competing interest with any other research group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;Clinical trial number: not applicable.\u0026rsquo;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHelena KK, Kristina GD. Prevention of unintended pregnancy and use of contraception -important factors for preconception care. Ups J Med Sci. 2016,121(4):252\u0026ndash;255.\u003c/li\u003e\n\u003cli\u003eContraception. https://www.who.int/health-topics/contraception#tab=tab_1 (Downloaded on 20 October,2025) \u003c/li\u003e\n\u003cli\u003eMegan LK, Ragnar MA. Contraception and beyond: the health benefits of services provided at family planning centers, 2013. https://www.guttmacher.org/sites/default/files/pdfs/pubs/health-benefits.pdf (Downloaded on 10 September,2025) \u003c/li\u003e\n\u003cli\u003eKathya LC, Graciela CP, Ana M, Gabriela P, Diva ML, Ivan C. Sexual and reproductive rights for contraception in Bolivia, Colombia and Uruguay in the framework of human rights Rev Panam Salud Publica. 2017;41: e140. \u003c/li\u003e\n\u003cli\u003eReproductive rights are human rights a handbook for national human rights institutions. https://www.ohchr.org/sites/default/files/Documents/Publications/NHRIHandbook.pdf\u003c/li\u003e\n\u003cli\u003eWomen\u0026rsquo;s and girls\u0026rsquo; reproductive choices must be respected, UN experts. https://www.ohchr.org/en/statements-and-speeches/2022/09/womens-and-girls-reproductive-choices-must-be-respected-un-experts (12 September 2025)\u003c/li\u003e\n\u003cli\u003ePierre M, Alain KK, Philip A, Peter G, Georges G, Funmilola O, Elizabeth O, Sodani PR , Mary T, Pierre A, Amy T, Scott R. Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption. Health Policy Plan. 2021, 17;36(3):273-287.\u003c/li\u003e\n\u003cli\u003eGrindlay K., Turyakira E, Kyamwanga IT, Nickerson A, Blanchard K. The human face of contraceptive stock-outs: a qualitative study in Uganda, 2016. https://www.rhsupplies.org/uploads/tx_rhscpublications/Uganda_Stockouts_Brief_by_IBIS.pdf (12 November, 2025)\u003c/li\u003e\n\u003cli\u003eAmy MM, Mona B. Family planning and reproductive health supply stockouts: problems and remedies for faith-based health facilities in Africa. Christian J Global Health 2017, p19-29\u003c/li\u003e\n\u003cli\u003eKate G, Eleanor T, Imelda TK, Adrianne N, Kelly B. The Experience and impact of contraceptive stockouts among women, providers and policymakers in two districts of Uganda. Int Perspect Sexual Reprod Health. 2016, 42(3):141-150.\u003c/li\u003e\n\u003cli\u003eAyele H, Abebe G. Determinants of contraceptive stock-outs in public health facilities in Southern Ethiopia: A mixed-methods study. Ethiopian J Health Development. 2023, 37(1), 55-65..\u003c/li\u003e\n\u003cli\u003eChukwu E, Abiodun P, Okon M. \u003cem\u003eContraceptive stock-outs and service disruptions in primary healthcare facilities in Nigeria: A cross-sectional analysis\u003c/em\u003e. African J Reprod Health, 2023,27(2), 34-41. .\u003c/li\u003e\n\u003cli\u003eMuhoza P, Koffi AK, Anglewicz P, Gichangi P, Guiella G, Olaolorun F, et al. Modern contraceptive availability and stockouts: A multi-country analysis of trends in supply and consumption. Health Policy Plan. 2021,36(3):273-287. \u003c/li\u003e\n\u003cli\u003eMukasa B, Ali M, Farron M, Van de Weerdt R.. Contraception supply chain challenges: a review of evidence from low- and middle-income countries. The European J Contraception \u0026amp;Amp; Reproductive Health Care, 2017, 22(5),384-390. \u003c/li\u003e\n\u003cli\u003eBakali M. Contraception supply chain challenges: a review of evidence from low- and middle-income countries. The European J Contraception Reprod Health Care.2017, 22(51). DOI:10.1080/13625187.2017.1394453\u003c/li\u003e\n\u003cli\u003eBearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990\u0026ndash;2019. \u003cem\u003eLancet Global Health\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2020;8(9):e1152\u0026ndash;e1161. \u003c/li\u003e\n\u003cli\u003eInvesting in Sexual and Reproductive Health in Low- and Middle-Income Countries. Fact Sheet. July 2020. https://www.guttmacher.org/fact-sheet/investing-sexual-and-reproductive-health-low-and-middle-income-countries\u003c/li\u003e\n\u003cli\u003eVijayan KP, Julieann LN. Unmet family planning need globally: A clarion call for sharpening current research frame works. Open Access J Contracept. 2023; 14:139-147.\u003c/li\u003e\n\u003cli\u003eZuniga C, Wollum A, Grindlay K, Higgins S, Blanchard K. The impacts of contraceptive stock-outs on users, providers, and facilities: A systematic literature review 2 3. Global Public Health, 2022; 17(1), 83-99\u003c/li\u003e\n\u003cli\u003eTumlinson K, Britton LE, Goland E, Chung S, Bullington BW, Williams CR, et al. Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study. BMC Health Serv Res. 2023, 23(1), 74.\u003c/li\u003e\n\u003cli\u003eIryanyawera MC. Associated factors with stock-out for modern contraceptives in health facilities in Rwanda. Master\u0026apos;s thesis, University of Rwanda, 2016. Available at: https://dr.ur.ac.rw/bitstream/handle/123456789/452/Iryanyawera.pdf?sequence=1\u003c/li\u003e\n\u003cli\u003eGaby I, Denis K, Tim R. Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia .BMC Public Health . 2020, 20(1):1053\u003c/li\u003e\n\u003cli\u003eGrindlay K, Turyakira E, Kyamwanga IT, Nickerson A, Blanchard K. The experience and impact of contraceptive stockouts among women, providers and policymakers in two districts of Uganda. Int Perspect Sexual Reprod Health. 2022,42, 141-150\u003c/li\u003e\n\u003cli\u003eWhidden C, Keita Y, Treleaven, E. \u003cem\u003eet al.\u003c/em\u003eWomen\u0026rsquo;s empowerment, intrahousehold influences, and health system design on modern contraceptive use in rural Mali: a multilevel analysis of cross-sectional survey data. Reprod Health. 2021, 18, 55. \u003c/li\u003e\n\u003cli\u003eOrsola T. Violent instability and modern contraception: Evidence from Mali World Development. 2024,177, 106538\u003c/li\u003e\n\u003cli\u003eTefera BB, Yihunie W, Bekele A. Integrated pharmaceutical logistics system implementation in chagni primary hospital and injibara general hospital, awi zone, Ethiopia. J Multidiscip Healthc. 2021;14:1673\u0026ndash;682\u003c/li\u003e\n\u003cli\u003eFMoH. Ethiopian Demographic and Health Survey 2019: Key Indicators Report. FMoH [Internet]. 2020;1-49. \u003c/li\u003e\n\u003cli\u003eFMoH-Ethiopia. Health Sector Translaformation Plan II (HSTP II). Ethiop Minist Health. 2021;25:96. \u003c/li\u003e\n\u003cli\u003eCSA, 2007: https://www.ethiopianreview.com/pdf/001/Cen2007_firstdraft \u003c/li\u003e\n\u003cli\u003eThe Global programme to enhance reproductive health commodity security [Internet]. 2023. Available from: www.unfpa.org (Accessed 25 August 2025)\u003c/li\u003e\n\u003cli\u003eSexual \u0026amp; Reproductive Health Commodities: Measuring Prices, Availability \u0026amp; Affordability; Methodology \u0026amp; Data Entry Manual (First Edition).( https://haiweb.org/storage/2017/10/Survey-Methodology-SRHR-3.pdf (Downloaded on 23 Nov, 2025)\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMeasurement Report: Family Planning Trends in Sub-Saharan Africa\u003c/em\u003e\u003cem\u003e. \u003c/em\u003eFP2030, 2023.[ https://www.fp2030.org] \u003c/li\u003e\n\u003cli\u003eFekadu GD, Mekonnen HH, Getachew M. LMIS performance for program drugs in East Wollega, Oromia Region. \u003cem\u003eJ Pharmaceutical Policy and Practice\u003c/em\u003e, 2022;15, DOI:10.1093/heapol/czx134\u003c/li\u003e\n\u003cli\u003eZimmerman LA, Bell SO, Li Q, Morzenti A, Anglewicz P, Tsui AO. Individual, community and service environment factors associated with modern contraceptive use in five Sub-Saharan African countries: A multilevel, multinomial analysis using geographically linked data from PMA2020. \u003cem\u003eRes Rev Healthcare: Open Access J\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2019.6(4), 216-219.\u003c/li\u003e\n\u003cli\u003eMekonnen WT. Assessing the availability of contraceptives in public health facilities in East Africa: A cross-sectional study. Reproductive Health. 2022, 19(1), 45. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eModel list of essential medicines\u003c/em\u003e (22nd ed.), 2023\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Contraceptive stock-out, family planning, health facilities, supply, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8613593/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8613593/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFamily planning services enable individuals to make informed reproductive choices. In Ethiopia, frequent stock-outs persist despite national guidelines and supply chain reforms. This study assessed the impact of these stock-outs on reproductive health outcomes and family planning services in Hawassa City.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe main objective to assess contraceptive stock-outs and its associated factors in public health facilities of Hawassa City, Sidama Ethiopia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA facility-based cross-sectional survey was carried out at four health centers and three randomly chosen public hospitals in Hawassa City from May 20 to June 30, 2025. FP records and structured questionnaires were used to gather data. Data were coded, entered into Kobo Toolbox, and SPSS version 26 was used for analysis. Both inferential and descriptive statistics were used. To evaluate relationships between dependent and independent variables, bivariate and multivariate logistic regressions were used. P-values less than 0.05 were regarded as statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e134 (58.5%) of the 229 participants (100% response rate) reported stock-outs lasting two to four weeks, while 83 (36.3%) [95%, CI: (30.1%, 42.5%) reported weekly stock-outs. AOR\u0026thinsp;=\u0026thinsp;2.44, 95% CI [1.35\u0026ndash;4.42], p\u0026thinsp;\u0026lt;\u0026thinsp;0.003, facilities\u0026thinsp;\u0026ge;\u0026thinsp;20 km from the district pharmacy (AOR\u0026thinsp;=\u0026thinsp;2.5, 95% CI [1.3\u0026ndash;4.8], p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), and facilities without trained FP staff (AOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI [1.4\u0026ndash;6.7], p\u0026thinsp;\u0026lt;\u0026thinsp;0.004) all had higher odds of stock-outs, while updated stock records decreased the likelihood (AOR\u0026thinsp;=\u0026thinsp;0.4, 95% CI [0.2\u0026ndash;0.9], p\u0026thinsp;\u0026lt;\u0026thinsp;0.02). These structural and organisational factors were significant determinants. The most frequent complaints were from clients (215, 94.1%), service interruptions (38, 16.6%), unmet needs (17, 7.4%), and unplanned pregnancies (15, 6.5%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSystemic and organizational problems are the main causes of the frequent contraceptive stock-outs in Hawassa City, which largely result in client discontent and, to a lesser extent, service interruptions, unmet need, and unplanned births.\u003c/p\u003e\u003ch2\u003eRecommendations:\u003c/h2\u003e \u003cp\u003eStrengthen supply chains, improve inventory management, enhance staff capacity, prioritize health centers, and address structural barriers to ensure consistent access to all FP methods, particularly LARC, and improve client satisfaction.\u003c/p\u003e","manuscriptTitle":"Assessment of Contraceptive Stock-Out and Its Associated Factors in Public Health Facilities of Hawassa City, Southern Ethiopia: A Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 09:10:38","doi":"10.21203/rs.3.rs-8613593/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55d9251c-95c1-474e-bff0-ae707994c529","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T06:55:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 09:10:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8613593","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8613593","identity":"rs-8613593","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}