Renewing focus on family planning service quality globally

Building trust through quality of service mediated with satisfaction to acceptors of family planning in the province of South Kalimantan

This study aims to analyze the effect of service quality on the satisfaction of Long-Term Contraception Method family planning acceptors, analyze the effect of family planning service quality on the trust of Long-Term Contraception Method family planning acceptors, analyzing the effect of acceptor satisfaction on trust, and analyzing the effect of service quality on trust which is mediated by the satisfaction of couples of Long-Term Contraception Method acceptors. So that it can be a reference in making future family planning programs so that it is right on target and can control the rate of population growth. This study uses a quantitative approach, namely research that emphasizes analysis of numerical data obtained by statistical methods to test hypotheses so that the significance of the relationship between the variables studied is obtained. The number of samples in this study was 120 respondents in data collection using multistage sampling and simple random sampling techniques, data analysis techniques using path analysis using the SEM-PLS program. The results showed that the variable quality of family planning officers had a positive and significant effect on the satisfaction of family planning acceptors, the variable of service quality of family planning officers had a positive and significant effect on the trust of family planning acceptors, the variable of satisfaction with family planning acceptors had a positive and significant effect on the trust of family planning acceptors, and the variable of service quality of family planning officers. positive and significant effect on the trust of family planning acceptors mediated by the satisfaction of family planning acceptors using Long-Term Contraception Method.

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18–49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%–89%) and Kaduna (66%–82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna.

Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis

Background

Despite the commitments of the government to minimize unintended pregnancy, abortion, and unmet need for contraceptives, as per our search of the literature, there is no study on the pooled prevalence and determinants of informed choice of contraceptive methods in sub-Saharan Africa. Therefore, this study aimed to assess the pooled prevalence and determinants of informed choice of contraceptive methods among reproductive-aged women in sub-Saharan Africa.

Methods

This study was based on the 32 Sub-Saharan African countries Demographic and Health Survey data. A total weighted sample of 65,487 women aged 15-49 was included in the study. The data were cleaned, weighted, and analyzed using STATA Version 14 software. Multilevel logistic regression modeling was used to identify determinants of an informed choice of contraceptive methods. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) and p-value < 0.05 were used to declare the significant determinants.

Result

The pooled prevalence of informed choice of contraceptive methods among reproductive age (15-49) women in sub-Saharan Africa was 49.47% (95%CI: 44.33, 54.62%) with I ² =99.5%, and variations in range of 19.42 to 78.42%. Women aged 25-34 years old (AOR = 1.26 95%CI: 1.21, 1.32) and 35-49 years (AOR = 1.33 95%CI: 1.27, 1.40), attending primary education (AOR = 1.26, 95% CI: 1.20, 1.32), secondary education (AOR = 1.50, 95% CI: 1.43, 1.58) and higher education (AOR = 2.01, 95% CI: 1.84, 2.19), having media exposure (AOR = 1.12, 95%CI: 1.07, 1.16), utilizing IUD (AOR = 1.98, 95%CI: 1.79, 2.19), injectable (AOR = 1.29, 95%CI: 1.23, 1.36) and implants (AOR = 1.70, 95%CI: 1.61, 1.79), survey year 2016-2020 (AOR = 1.38, 95%CI: 1.31, 1.44), women from lower middle (AOR = 1.25, 95%CI: 1.19, 1.31) and upper middle income level countries (AOR = 1.37, 95%CI: 1.23, 1.53) were associated with increased odds of informed choice of contraceptive methods. While, women who accessed contraceptives from private clinics (AOR = 0.64, 95%CI: 0.61, 0.67), pharmacies (AOR = 0.37, 95%CI: 0.35, 0.40), and others (AOR = 0.47, 95%CI: 0.43, 0.52), women in East Africa (AOR = 0.70, 95% CI: 0.67, 0.73), Central Africa (AOR = 0.52, 95% CI: 0.47, 0.57), and South Africa (AOR = 0.36, 95% CI: 0.32, 0.40) were associated with decreased odds of informed choice of contraceptive methods.

Conclusion

The pooled prevalence of informed choice of contraceptive methods in Sub-Saharan Africa is low with high disparities among the countries. Enhancing maternal education and media exposure, providing greater concern for the source of contraceptive methods, and strengthening the economic status of the country are recommended to enhance informed choice of contraceptive methods.

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

OBJECTIVES

(1) Summarise and evaluate the current evidence of tuberculosis (TB)-associated pregnancy outcomes, (2) evaluate the state of the science of family planning during TB treatment and (3) provide recommendations to move forward to improve care and outcomes during TB disease.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

DATA SOURCES

PubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021.

ELIGIBILITY CRITERIA

Studies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV coinfection and examined pregnancy, maternal, fetal/birth and TB or TB/HIV coinfection outcomes. Studies were also included if they examined family planning services among women initiating TB treatment.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data using PRISMA guidelines and conducted quality assessment using the Joanna-Briggs Institute Critical Appraisal Tools. The level of evidence was reported using the Johns Hopkins Evidence-Based Practice guidelines.

RESULTS

69 studies were included in this review. Case reports, case series, case controls, cohort studies, secondary data analyses and a service delivery improvement project conducted in 26 countries made up the totality of the evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, deaths) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies discussed the value of offering family planning to prevent adverse pregnancy outcomes. One study examined the effect of a provider training on contraceptive use with reported increased contraceptive use.

CONCLUSIONS

Integrating family planning services within a TB treatment programme is essential to reduce adverse TB-associated maternal-child outcomes. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes for women with TB/DR-TB. Recommendations for clinicians, TB programmes and researchers are provided and reflect evidence presented in this review.

Lived Experience of Women Who Underwent Early Removal of Long-Acting Family Planning Methods in Bedesa Town, Wolaita Zone, Southern Ethiopia: A Phenomenological Study

Background

Long-acting family planning method (LAFP) is a low-cost yet effective method of reducing maternal mortality, limiting and spacing childbirth. In Ethiopia, the family planning prevalence rate rises from 15% in 2005 to 36% in 2016. However, the discontinuation rate of LAFP is still high in the region. Therefore, the aim of this study was to explore the lived experiences of women who underwent early removal of long-acting family planning methods in Bedesa town, Southern Ethiopia.

Methods

An interpretative phenomenological study design was employed. Women aged 15–49 years who removed LAFP therapy in the past 12 months were our sampled population. Data were collected through in-depth interviews (IDIs) by using open-ended structured interview guide. Purposive sampling technique was used to select 10 participants from the family planning logbook registration of Bedesa health center. The interview continued until information saturation was reached. Open code version 4.03 was used to code and facilitate analysis. Transcripts were read and re-read separately to identify emerging themes. A thematic analysis technique was used.

Results

This study revealed that the side effects, seeking more children and the husband’s opposition were the main reason for early removal of LAFP. Amongst side effects, heavy and irregular menses were occurred most frequently. Besides, there were various myths and misconceptions about family planning methods. It also noted that the counseling services provided by health professionals were not adequate.

Conclusion

Side effects, desired to have more children, and the husband’s opposition are the most important reason of early removal of LAFP methods. Furthermore, there were misunderstanding, fear and rumors raised by women about each method. Hence, greater public awareness on family planning should be delivered to change community perception on LAFP methods.

A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation

Objective

We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy.

Study design

Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation (n = 558) and validation (n = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion. Predictive performance was evaluated using time-dependent receiver operating characteristic curves and area under the curve (AUC).

Results

The overall contraceptive discontinuation rate was 36.9 per 100 woman-years (95% confidence interval [CI] 30.3–44.9). The predictors of discontinuation selected for the risk score included use of a short-term method or copper intrauterine device (vs. injectable or implant), method continuation or switch (vs. initiation), < 9 years of completed education, not having a child aged < 6 months, and having no spouse or a spouse supportive of family planning (vs. having a spouse who has unsupportive or uncertain attitudes towards family planning). AUC at 24 weeks was 0.76 (95% CI 0.64–0.87) with 70.0% sensitivity and 78.6% specificity at the optimal cut point in the derivation cohort. Discontinuation was 3.8-fold higher among high- vs. low-risk women (95% CI 2.33–6.30). AUC was 0.68 (95% CI 0.47–0.90) in the validation cohort. A simplified score comprising routinely collected variables demonstrated similar performance (derivation-AUC: 0.73 [95% CI 0.60–0.85]; validation-AUC: 0.73 [95% CI 0.51–0.94]). Positive predictive value in the derivation cohort was 31.4% for the full and 28.1% for the simplified score.

Conclusions

The risk scores demonstrated moderate predictive ability but identified large proportions of women as high risk. Future research is needed to improve sensitivity and specificity of a clinical tool to identify women at high risk for experiencing method-related challenges.

Implications

Contraceptive discontinuation is a major driver of unmet contraceptive need globally. Few tools exist for identifying women who may benefit most from additional support in order to meet their contraceptive needs and preferences. This study developed and assessed the validity of a provider-focused risk prediction tool for contraceptive discontinuation among Kenyan women using modern contraception. High rates of early discontinuation observed in this study emphasize the necessity of investing in efforts to develop new contraceptive technologies and stronger delivery systems to better align with women's needs and preferences for voluntary family planning.

Quality of Long-acting Reversible Contraception Provision in Lomé, Togo

Context

Provision of high-quality contraceptive counseling and services is essential to ensure family planning (FP) programs are rights-based and voluntary. Togo’s modern contraceptive use has steadily increased with almost a quarter of the method mix attributed to long-acting reversible contraceptives (LARC). The purpose of this study is to assess the quality of LARC provision in Togo.

Methods

Data for this study were collected in 2016 as part of a larger research study conducted in Lomé, Togo to assess the effectiveness of the ongoing FP service delivery model. Quality of FP service was assessed in terms of program capacity and program performance. Program capacity was measured with five individual variables and program performance was measured with the Method Information Index (MII). Descriptive statistics and mixed effects models were used to assess likelihood of LARC uptake.

Results

Of the 669 clients included in the study, 19.4% received a LARC method. Multivariable results show that LARC uptake is significantly associated with supervisory visit at the facility in the last three months (program capacity indicator) (OR 1.44; 95%CI 1.48–2.39) and is twice as likely for those with a positive MII score, even after controlling for provider and client characteristics (OR 2.1; 95%CI 1.61–2.51).

Conclusion

This study identified supervisory visits and comprehensive contraceptive counseling as the key quality factors positively associated with uptake of LARC. Continued focus on quality of care and provider–client information exchange is necessary to ensure women’s FP needs are met.

Trends and Contributing Factors to Contraceptive Use in Kenya: A Large Population-Based Survey 1989 to 2014

Kenya is among the leading nations in family planning in Africa, having the first official nationwide family planning program in sub-Saharan Africa. However, Kenya is still one of the most highly populated countries in Africa with a population of more than 52 million. The objective of this study was to assess the trends and contributing factors of contraceptive use. We conducted a multi-wave cross-sectional study using both the demographic health survey (DHS) and family planning effort index (FPE) datasets, analyzing five-year waves from 1989 to 2014. This study indicates that contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women's characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046-1.065). There was a fluctuating trend of the additional FPE components throughout the years. Women with lower education, those married to husbands with lower education, unmarried, and rural women remain behind in family planning service utilization. Targeted programs are still needed for these special groups. Policy adherence is vital for continued progress.

Successful programmatic approaches to facilitating IUD uptake: CARE's experience in DRC

Background

Achieving the unfinished agenda towards sexual and reproductive health and rights requires overcoming remaining barriers to contraceptive uptake, which can be method-specific. Women’s uptake of the IUD is poor across sub-Saharan Africa. The objective of this paper is to identify the reasons for comparatively high IUD use observed in a CARE project in DRC, together with the programmatic characteristics which facilitated uptake.

Methods

Qualitative data were collected in 2015 as part of a reproductive health project in the DRC. Using purposive sampling, 15 focus group discussions took place with IUD users, users of other methods and non-users of modern contraception as well as their male partners. Eighteen in-depth interviews were conducted with health providers, project staff, community health workers and local stakeholders to capture a range of experiences. Data were analyzed using content theory approach and contextualized through a review of routine monitoring data.

Results

In an area with practically no previous IUD use, 38,662 new FP clients were served during the first 5 years of the project and 82% (31,569) chose long-acting or permanent methods. Over 10,000 clients chose an IUD, representing 30% of the total FP clients. Key informants expressed mainly positive views about the IUD and quality of service. Concerns related to method insertion, which some perceived as too intimate or shameful. Findings indicate that this uptake reflects effective supply chains, good provider training and supervision and multiple communication strategies including those which target men. Community engagement was enhanced by local stakeholders’ participation in sensitization and quality assurance as well in analysis of data for decision-making.

Conclusions

The findings of the paper showed that by involving local stakeholders in addressing structural and socio-cultural barriers to women’s free access to FP, programs can positively influence quality of service and method mix as well as knowledge and attitudes surrounding FP use and thus improve the uptake of FP in general and IUDs in particular, even in conflict-affected settings. A Theory of Change for enhancing IUD provision within family planning programs is suggested.

Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia

BACKGROUND

Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation remains a major concern for family planning programs. In less developed countries, contraceptive discontinuation due to health concerns is generally higher, these complaints are often related to service quality. Significant numbers of women become exposed to conception after discontinuation and accidental pregnancies that end up with abortion & stillbirth. The aim of this study was to assess the early discontinuation rate of Implanon and identify its associated factors among women who ever used Implanon in 2016 in Dale district, Southern Ethiopia.

METHODS

Community based cross-sectional study design was conducted from January to February, 2017. A total number of 711 women who ever used Implanon in 2016 were selected using multistage sampling. The data were entered and cleaned in Epi Info and analyzed using SPSS. Multivariate logistic regression analysis was used to determine the effect of factors on the outcome variables. Finally, the results were presented using adjusted odds ratio (AOR) & confidence interval of 95%.

RESULT

Early Implanon discontinuation rate in this study was 160 (23.4%) with a mean duration of Implanon use of 9.6 ± 2.5 months. The main reasons for discontinuation of Implanon were 55 (34.4%) the facing of side effects. Factors for discontinuation of Implanon were women age 20-24 years (AOR =. 44 (95% CI: 23-. 85), 25-29 years (AOR =. 52 (95% CI: 27-. 96), 35+ years, (AOR =. 08 (95% CI: 02-. 41), less likely to discontinue. Women who weren't counseled about the side effects during Implanon insertion were 1.93 times (AOR = 1.93 (95% CI: 1.27-2.93), women who didn't satisfied by the service (AOR = 2.55(CI: 95%: 1.63-3.97), women who didn't appointed for follow up (AOR = 3.13 (CI: 95%: 2.0-4.95), women who didn't choose the method by themselves (AOR = 1.83 (CI: 95%: 1.18-2.83) and women who didn't have information on family planning before Implanon insertion (AOR = 1.52 (CI: 95%: 1.1-2.28) were the predictors of Implanon discontinuation.

CONCLUSIONS

Implanon discontinuation rate in this study area was high. Appropriate counseling prior to insertion and proper follow up, autonomous choice will improve the continuation rate of Implanon.

Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature

Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method—about two times more frequently—among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13–2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method.