From Stock-Outs to Choice: How Strengthening Last-Mile Supply Chains Transformed Family Planning Access in Northern Nigeria

Abstract

Background: In Nigeria, unmet need for family planning remains a major barrier to reproductive rights and maternal health, particularly in high‑population states such as Kaduna and Kano. Frequent stock‑outs of modern contraceptives at the last mile have historically limited clients’ ability to access their preferred methods, contributing to dissatisfaction, discontinuation, and unmet fertility intentions. Methods: This article analyzes the impact of the Strengthening Integrated Last Mile Delivery and Supply Visibility (SILMD & SV) Pilot Project, implemented between April 2025 and February 2026 in Kaduna and Kano States in northern Nigeria. Using a mixed-methods approach, quantitative service delivery and commodity availability data were compared across pre- and post-rollout periods, and qualitative insights were obtained through interviews with service providers across 32 rural, semi-urban, and urban health facilities. Results: Family planning commodity availability increased substantially, rising from 24% to 70% in Kaduna State and from 18% to 78% in Kano State following project-supported last‑mile distribution. This improvement coincided with marked increases in service uptake across nearly all contraceptive methods. New female acceptors increased by 56% in Kaduna State and 61% in Kano State, while male acceptors rose by 47% and 247%, respectively. Uptake of injectables and implants showed the most pronounced growth, reflecting client preferences for longer‑acting methods. Qualitative findings attributed increased turnout to reliable availability, reduced client disappointment, and improved trust in health facilities, while also highlighting persistent challenges related to myths, misconceptions, and self‑injection confidence. Conclusion: Strengthening last‑mile supply chains is a critical enabler of contraceptive choice and service uptake. However, sustained gains require complementary demand‑side interventions, provider engagement, and community sensitization to address misconceptions. The SILMD & SV Pilot Project demonstrates a scalable model for improving family planning access and advancing reproductive agency in Nigeria and similar settings.