Spatial distribution, integration and determinants of family planning service provision in Lubumbashi, DRC: a cross-sectional analysis from a health facility census.

BACKGROUND: Universal access to family planning (FP) services is essential for safeguarding sexual and reproductive health and rights. Integration of FP and routine maternal and child health (MCH) services has been associated with increased uptake of long-acting reversible contraceptives and contributes to reduced unintended pregnancies, unsafe abortions and complications associated with short interpregnancy intervals. In the DRC, FP use remains limited despite national efforts to expand services, and rapidly growing cities such as Lubumbashi face additional challenges due to health system fragmentation and reliance on private-sector care. This study examined spatial distribution, MCH-integration and determinants of FP service provision in Lubumbashi. METHODS: We analysed data from a 2023 census of 1,267 health facilities in Lubumbashi. Descriptive analyses summarized the availability of FP services in facilities by health zone, sector, type, routine-data integration, MCH services, -integration, monthly birth volume, medicine stock and mean cost of vaginal birth. Multilevel logistic regression models with random intercepts at the health zone level identified facility-level determinants of FP service provision. Geospatial analyses mapped service availability with 1 km coverage buffers, population-adjusted facility density, and FP-MCH integration levels by health zone. RESULTS: Overall, 731 facilities reported offering FP services (57.7% of total), with significant variation across health zones (31.0–70.5%). FP provision was strongly associated with high monthly birth volumes (aOR = 8.14, 95% CI 2.81–23.58), public ownership (aOR 4.09, 95% CI 1.62–9.99), and integration with all types of MCH services. Geospatial mapping showed that 94.3% of women live within a 1 km radius of a facility offering FP, but FP services and FP-MCH integration were less dense in peripheral health zones. CONCLUSION: Despite near universal geographic access to FP in Lubumbashi, service integration with MCH-services remains suboptimal, and coverage gaps persist in peripheral areas. The city should prioritise under-served health zones for both health facility based and outreach FP interventions to guarantee universal FP access, and efforts should be made to expand subsidized or free services in areas dominated by private for-profit facilities. Additional barriers such as stockouts, costs, fear of side effects, misinformation or partner-related constraints warrant further investigation.