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Sileo KM, Muhumuza C, Tuhebwe D, Muñoz S, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. "The burden is upon your shoulders to feed and take care of your children, not religion or culture": qualitative evaluation of participatory community dialogues to promote family planning's holistic benefits and reshape community norms on family success in rural Uganda. Contracept Reprod Med 2024; 9:28. [PMID: 38835058 PMCID: PMC11149320 DOI: 10.1186/s40834-024-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Family planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish's social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda. METHODS This study aimed to qualitatively evaluate the effect of FH = FW's community dialogue approach on participants' personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis. RESULTS The community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW's inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men's acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples' collective family planning (and overall health) decision-making and uptake of contraceptive methods. CONCLUSION Community dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level. TRIAL REGISTRATION Clinicaltrials.gov (NCT04262882).
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, 30A Plot, 30A York Terrace, Kampala, Uganda
| | - Doreen Tuhebwe
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Rhoda K Wanyenze
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Science, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Samuel Sekamatte
- Butambala District Health Department, Gombe Hospital, Gombe, Uganda
| | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
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Sudhinaraset M, Gipson JD, Nakphong MK, Soun B, Afulani PA, Upadhyay UD, Patil R. Person-centered abortion care scale: Validation for medication abortion in the United States. Contraception 2024:110485. [PMID: 38754758 DOI: 10.1016/j.contraception.2024.110485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. STUDY DESIGN This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. RESULTS Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. CONCLUSION This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. IMPLICATIONS This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.
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Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States.
| | - Jessica D Gipson
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States
| | - Michelle K Nakphong
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Brenda Soun
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Patience A Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rajita Patil
- UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States
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Wollum A, Moucheraud C, Gipson JD, Friedman W, Shah M, Wagner Z. Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso: A mixed-methods study. Soc Sci Med 2024; 348:116826. [PMID: 38581812 DOI: 10.1016/j.socscimed.2024.116826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
Provider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care. First, we surveyed providers in Tanzania and Burkina Faso (N = 295) to assess provider attitudes about young, unmarried, and nulliparous clients. Second, mystery clients anonymously visited providers for contraceptive care and we randomly assigned the reported age, marital status, and parity of each visit (N = 306). We used data from these visits to investigate contraceptive care disparities across 3 domains: information provision and counseling quality, contraceptive method provision, and perceived treatment. Third, we complemented mystery client data with client exit surveys (N = 31,023) and client in-depth interviews (N = 36). In surveys, providers reported biased attitudes against young, unmarried, and nulliparous clients seeking contraceptives. Similarly, we found disparities according to these characteristics in the reporting of contraceptive care quality; however, we found that each characteristic affected a different quality of care domain. Among mystery clients we found age-related disparities in the provision of methods; 16/17-year-old clients were 18 and 11 percentage points less likely to perceive they could take a contraceptive method relative to 24-year-old clients in Tanzania and Burkina Faso, respectively. Unmarried mystery clients perceived worse treatment from providers compared to married clients. Nulliparous mystery clients reported lower quality contraceptive counseling than their parous counterparts. These results suggest that clients of different characteristics likely experience bias across different elements of care. Improving care quality and reducing disparities will require attention to which elements of care are deficient for different types of clients.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, University of California, Los Angeles, USA.
| | - Corrina Moucheraud
- Department of Public Health Policy & Management, New York University, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, University of California, Los Angeles, USA
| | | | - Manisha Shah
- Goldman School of Public Policy, University of California, Berkeley, USA
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Muga W, Juma K, Athero S, Kimemia G, Bangha M, Ouedraogo R. Barriers to post-abortion care service provision: A cross-sectional analysis in Burkina Faso, Kenya and Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001862. [PMID: 38452008 PMCID: PMC10919639 DOI: 10.1371/journal.pgph.0001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024]
Abstract
Despite several political commitments to ensure the availability of and access to post-abortion care services, women in sub-Saharan Africa still struggle to access quality post-abortion care, and with devastating social and economic consequences. Expanding access to post-abortion care while eliminating barriers to utilization could significantly reduce abortions-related morbidity and mortality. We describe the barriers to providing and utilizing post-abortion care across health facilities in Burkina Faso, Kenya, and Nigeria. This paper draws on three data sources: health facility assessment data, patient-exit interview data, and qualitative interviews conducted with healthcare providers and policymakers. All data were based on a cross-sectional survey of a nationally representative sample of health facilities conducted between November 2018 and February 2019. Data on post-abortion care service indicators were collected, including staffing levels and staff training, availability of post-abortion care supplies, equipment and commodities. Patient-exit interviews focused on patients treated for post-abortion complications. In-depth interviews were conducted with healthcare providers within a sample of the study health facilities and national or local decision-makers in sexual and reproductive health. Few primary-level facilities in Burkina Faso (15%), Kenya (46%), and Nigeria (20%) had staff trained on post-abortion care. Only 16.6% of facilities in Kenya had functional operating theaters or MVA rooms, Burkina Faso (20.3%) and Nigeria (50.7%). Primary facilities refer post-abortion care cases to higher-level facilities despite needing to be more adequately equipped to facilitate these referrals. Several challenges that impede the provision of quality and comprehensive post-abortion care across the three countries. The absence of post-abortion care training, equipment, and inadequate referral capacity was among the critical reasons for the lack of services. There is a need to strengthen post-abortion care services across all levels of the health system, but especially at lower-level facilities where most patients seek care first.
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Affiliation(s)
- Winstoun Muga
- African Population Health and Research Center, Nairobi, Kenya
| | - Kenneth Juma
- African Population Health and Research Center, Nairobi, Kenya
| | - Sherine Athero
- African Population Health and Research Center, Nairobi, Kenya
| | - Grace Kimemia
- African Population Health and Research Center, Nairobi, Kenya
| | - Martin Bangha
- African Population Health and Research Center, Nairobi, Kenya
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Wollum A, Moucheraud C, Sabasaba A, Gipson JD. Removal of long-acting reversible contraceptive methods and quality of care in Dar es Salaam, Tanzania: Client and provider perspectives from a secondary analysis of cross-sectional survey data from a randomized controlled trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002810. [PMID: 38261598 PMCID: PMC10805313 DOI: 10.1371/journal.pgph.0002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Access to removal of long-acting reversible contraception (LARCs) (e.g., implants and intrauterine devices (IUDs)) is an essential part of contraceptive care. We conducted a secondary analysis of cross-sectional survey data from a randomized controlled trial. We analyzed 5,930 client surveys and 259 provider surveys from 73 public sector facilities in Tanzania to examine the receipt of desired LARC removal services among clients and the association between receipt of desired LARC removal and person-centered care. We used provider survey data to contextualize these findings, describing provider attitudes and training related to LARC removals. All facilities took part in a larger randomized controlled trial to assess the Beyond Bias intervention, a provider-focused intervention to reduce provider bias on the basis of age, marital status, and parity. Thirteen percent of clients did not receive a desired LARC removal during their visit. Clients who were young, had lower perceived socioeconomic status, and visited facilities that did not take part in the Beyond Bias intervention were less likely to receive a desired removal. Clients who received a desired LARC removal reported higher levels of person-centered care (β = .07, CI: .02 - .11, p = < .01). Half of providers reported not being comfortable removing a LARC before its expiration (51%) or if they disagreed with the client's decision (49%). Attention is needed to ensure clients can get their LARCs removed when they want to ensure patient-centered care and protect client autonomy and rights. Interventions like the Beyond Bias intervention, may work to address provider-imposed barriers to LARC removals.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
- The UCLA Bixby Center on Population and Reproductive Health, Los Angeles, California, United States of America
| | - Corrina Moucheraud
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City, New York, United States of America
| | - Amon Sabasaba
- Health for a Prosperous Nation (H-PON), Dar es Salaam, Tanzania
| | - Jessica D. Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
- The UCLA Bixby Center on Population and Reproductive Health, Los Angeles, California, United States of America
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Ouattara M, Sié A, Seynou M, Kagoné M, Bountogo M, Kouanda I, Ouédraogo R, Bangha M, Juma K, Athero S. Profil des utilisatrices et facteurs associés à la satisfaction des clientes de la qualité des soins après avortement au Burkina Faso: étude transversale menée dans six régions. Sex Reprod Health Matters 2024; 31:2272483. [PMID: 38189431 PMCID: PMC10810668 DOI: 10.1080/26410397.2023.2272483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
RésuméMalgré la dépénalisation de l'avortement et la gratuité des soins après avortement (SAA), les femmes Burkinabè vivent des relations difficiles avec les soignants. Cette étude vise à déterminer le profil des femmes recevant des SAA, leur perception de la qualité des SAA et ses déterminants dans des structures sanitaires publiques et confessionnelles du pays. Une enquête quantitative a été menée auprès de 2174 femmes vues pour des SAA et recrutées de façon exhaustive de 2018 à 2020. Un questionnaire structuré a été administré à la sortie des soins. Une analyse uni-, bi- et multivariée a été faite. La majorité des clientes de SAA vivait en milieu rural (55%), avait 25 ans et plus (60%), vivait en couple (87%) et était sans-emploi (59%). La grossesse était non désirée chez 17% des femmes et 4% d'entre elles souhaitaient avorter. La satisfaction globale de la qualité des SAA était de 84%. Dans l'analyse multivariée, ses déterminants étaient la résidence en milieu rural (OR = 1.80 [1.38; 2.34]), un niveau scolaire primaire (OR = 1.48 [1.06; 2.07]) ou secondaire (OR = 1.95 [1.38; 2.74]), et avoir eu au moins un enfant (OR = 1.43 [1.02; 2.00]). Les facteurs associés à une faible satisfaction des SAA étaient une grossesse non désirée (OR = 0.64 [0.46; 0.89]) ou avoir souhaité avorter (OR = 0.09 [0.05; 0.16]). Le niveau de satisfaction globale est acceptable mais faible chez les clientes ayant souhaité avorter. Il est fondamental d'organiser un programme de formation des professionnels des SAA sur la communication, la relation interpersonnelle et l'empathie pendant les soins de santé.
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Affiliation(s)
- Mamadou Ouattara
- Chercheur, MD, épidémiologiste et Biostatisticien, Centre de recherche en santé de Nouna, Nouna, Burkina Faso. Correspondence:
- Chercheur, Directeur, MD, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- Scientifique d'appui (Guest Scientist), Institut de santé mondiale de Heidelberg, Heidelberg, Allemagne
- Chercheur associé, Université de Californie à San Francisco, San Francisco, États-Unis
- Chercheure, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Mariam Seynou
- Enseignant chercheur, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Moubassira Kagoné
- Chercheur, socio-anthropologue, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Mamadou Bountogo
- Chercheure, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Idrissa Kouanda
- Gestionnaire des bases de données, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Ramatou Ouédraogo
- Chercheure, socio-anthropologue, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Martin Bangha
- Chercheur, démographe, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Kenneth Juma
- Statisticien, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Sherine Athero
- Gestionnaire des bases de données, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
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Gausman J, Saggurti N, Adanu R, Bandoh DAB, Berrueta M, Chakraborty S, Kenu E, Khan N, Langer A, Nigri C, Odikro MA, Pingray V, Ramesh S, Vázquez P, Williams CR, Jolivet RR. Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM). PLoS One 2023; 18:e0293586. [PMID: 37922257 PMCID: PMC10624301 DOI: 10.1371/journal.pone.0293586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Integrating measures of respectful care is an important priority in family planning programs, aligned with maternal health efforts. Ensuring women can make autonomous reproductive health decisions is an important indicator of respectful care. While scales have been developed and validated in family planning for dimensions of person-centered care, none focus specifically on decision-making autonomy. The Mothers Autonomy in Decision-Making (MADM) scale measures autonomy in decision-making during maternity care. We adapted the MADM scale to measure autonomy surrounding a woman's decision to use a contraceptive method within the context of contraceptive counselling. This study presents a psychometric validation of the Family Planning Autonomous Decision-Making (FP-ADM) scale using data from Argentina, Ghana, and India. METHODS AND FINDINGS We used cross-sectional data from women in four subnational areas in Argentina (n = 890), Ghana (n = 1,114), and India (n = 1,130). In each area, 20 primary sampling units (PSUs) were randomly selected based on probability proportional to size. Households were randomly selected in Ghana and India. In Argentina, all facilities providing reproductive and maternal health services within selected PSUs were included and women were randomly selected upon exiting the facility. Interviews were conducted with a sample of 360 women per district. In total, 890 women completed the FP-ADM in Argentina, 1,114 in Ghana and 1,130 in India. To measure autonomous decision-making within FP service delivery, we adapted the items of the MADM scale to focus on family planning. To assess the scale's psychometric properties, we first examined the eigenvalues and conducted a parallel analysis to determine the number of factors. We then conducted exploratory factor analysis to determine which items to retain. The resulting factors were then identified based on the corresponding items. Internal consistency reliability was assessed with Cronbach's alpha. We assessed both convergent and divergent construct validity by examining associations with expected outcomes related to the underlying construct. The Eigenvalues and parallel analysis suggested a two-factor solution. The two underlying dimensions of the construct were identified as "Bidirectional Exchange of Information" (Factor 1) and "Empowered Choice" (Factor 2). Cronbach's alpha was calculated for the full scale and each subscale. Results suggested good internal consistency of the scale. There was a strong, significant positive association between whether a woman expressed satisfaction with quality of care received from the healthcare provider and her FP-ADM score in all three countries and a significant negative association between a woman's FP-ADM score and her stated desire to switch contraceptive methods in the future. CONCLUSIONS Our results suggest the FP-ADM is a valid instrument to assess decision-making autonomy in contraceptive counseling and service delivery in diverse low- and middle-income countries. The scale evidenced strong construct, convergent, and divergent validity and high internal consistency reliability. Use of the FP-ADM scale could contribute to improved measurement of person-centered family planning services.
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Affiliation(s)
- Jewel Gausman
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Maternal and Child Health Nursing Department, School of Nursing, University of Jordan, Amman, Jordan
| | | | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A. B. Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carolina Nigri
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Magdalene A. Odikro
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Veronica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Health Science, Kinesiology and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Caitlin R. Williams
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - R. Rima Jolivet
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Baum SE, Jacobson L, Ramirez AM, Katz A, Grosso B, Bercu C, Pearson E, Gebrehanna E, Chakraborty NM, Dirisu O, Chowdhury R, Zurbriggen R, Filippa S, Tabassum T, Gerdts C. Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries. BMJ Open 2023; 13:e067513. [PMID: 37730400 PMCID: PMC10510917 DOI: 10.1136/bmjopen-2022-067513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion. METHODS We conducted interviews with people seeking abortion aged 15-41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants. RESULTS We identified six themes that contributed to high-quality abortion care from the clients' perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain. CONCLUSIONS People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, Oakland, California, USA
| | - Laura Jacobson
- Ibis Reproductive Health, Oakland, California, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Anna Katz
- Ibis Reproductive Health, Oakland, California, USA
- University of California Berkeley School of Law, Berkeley, California, USA
| | - Belen Grosso
- Colectiva Feminista La Revuelta, Neuquen, Argentina
| | - Chiara Bercu
- Ibis Reproductive Health, Oakland, California, USA
| | | | - Ewenat Gebrehanna
- School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Afulani PA, Nakphong MK, Sudhinaraset M. Person-centred sexual and reproductive health: A call for standardized measurement. Health Expect 2023; 26:1384-1390. [PMID: 37232021 PMCID: PMC10349248 DOI: 10.1111/hex.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
Person-centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person-centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person-centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person-centred care across the SRH continuum. PATIENT OR PUBLIC CONTRIBUTION: This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale.
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Affiliation(s)
- Patience A. Afulani
- Departments of Epidemiology and Biostatistics and Obstetrics, Gynecology, and Reproductive Sciences, School of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Michelle K. Nakphong
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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Merz-Herrala AA, Kerns JL, Logan R, Gutierrez S, Marshall C, Diamond-Smith N. Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality. Contraception 2023; 123:110000. [PMID: 36871620 PMCID: PMC9985539 DOI: 10.1016/j.contraception.2023.110000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic. STUDY DESIGN We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores. RESULTS Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively). CONCLUSIONS We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. IMPLICATIONS Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.
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Affiliation(s)
- Allison A Merz-Herrala
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States
| | - Rachel Logan
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Sirena Gutierrez
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nadia Diamond-Smith
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
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11
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Umar N, Hill Z, Schellenberg J, Tuncalp Ö, Muzigaba M, Sambo NU, Shuaibu A, Marchant T. Women's perceptions of telephone interviews about their experiences with childbirth care in Nigeria: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001833. [PMID: 37075047 PMCID: PMC10115259 DOI: 10.1371/journal.pgph.0001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023]
Abstract
Our objective is to investigate women's perceptions of phone interviews about their experiences with facility childbirth care. The study was conducted between October 2020 and January 2021, in Gombe State, Nigeria. Participants were women aged 15-49 years, who delivered in ten study Primary Health Care centres, provided phone numbers, and consented to a follow-up telephone interview about their childbirth experience. The phone interviews took place 14 months after the delivery and consisted of a quantitative survey about women's experiences of facility childbirth followed by a set of structured qualitative questions about their experiences with the phone survey. Three months later 20 women were selected, based on their demographic characteristics, for a further in-depth qualitative phone interview to explore the answers to the structured qualitative questions in more depth. The qualitative interviews were analysed using a thematic approach. We found that most of the women appreciated being called to discuss their childbirth experiences as it made them feel privileged and valued, they were motivated to participate as they viewed the topic as relevant and thought that their interview could lead to improvements in care. They found the interview procedures easy and perceived that the call offered privacy. Poor network connectivity and not owning the phone they were using presented challenges to some women. Women felt more able to re-arrange interview times on the phone compared to a face-to-face interview, they valued the increased autonomy as they were often busy with household chores and could rearrange to a more convenient time. Views about interviewer gender diverged, but most participants preferred a female interviewer. The preferred interview length was a maximum of 30 minutes, though some women said duration was irrelevant if the subject of discussion was important. In conclusion, women had positive views about phone interviews on experiences with facility childbirth care.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Özge Tuncalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Abdulrahman Shuaibu
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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12
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Karp C, OlaOlorun FM, Guiella G, Gichangi P, Choi Y, Anglewicz P, Holt K. Validation and Predictive Utility of a Person-Centered Quality of Contraceptive Counseling (QCC-10) Scale in Sub-Saharan Africa: A Multicountry Study of Family Planning Clients and a New Indicator for Measuring High-Quality, Rights-Based Care. Stud Fam Plann 2023; 54:119-143. [PMID: 36787283 PMCID: PMC11152181 DOI: 10.1111/sifp.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The lack of validated, cross-cultural measures for examining quality of contraceptive counseling compromises progress toward improved services. We tested the validity and reliability of the 10-item Quality of Contraceptive Counseling scale (QCC-10) and its association with continued protection from unintended pregnancy and person-centered outcomes using longitudinal data from women aged 15-49 in Burkina Faso, Kenya, and Nigeria. Psychometric analysis showed moderate-to-strong reliability (alphas: 0.73-0.91) and high convergent validity with greatest service satisfaction. At follow-up, QCC-10 scores were not associated with continued pregnancy protection but were linked to contraceptive informational needs being met among Burkinabe and Kenyan women; the reverse was true in Kano. Higher QCC-10 scores were also associated with care-seeking among Kenyan women experiencing side effects. The QCC-10 is a validated scale for assessing quality of contraceptive counseling across diverse contexts. Future work is needed to improve understanding of how the QCC-10 relates to person-centered measures of reproductive health.
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Affiliation(s)
- Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Funmilola M OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/University Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | | | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kelsey Holt
- Department of Family & Community Medicine, University of California, San Francisco, CA, 94110, USA
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13
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Senderowicz L, Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabré P, Sié A. Measuring Contraceptive Autonomy at Two Sites in Burkina Faso: A First Attempt to Measure a Novel Family Planning Indicator. Stud Fam Plann 2023; 54:201-230. [PMID: 36729070 PMCID: PMC10184300 DOI: 10.1111/sifp.12224] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso. We conducted a population-based survey with 3,929 women of reproductive age, testing an array of new survey items within the three subdomains of informed choice, full choice, and free choice. In addition to providing tentative estimates of the prevalence of contraceptive autonomy and its subdomains in our sample of Burkinabè women, we critically examine which parts of the proposed methodology worked well, what challenges/limitations we encountered, and what next steps might be for refining, improving, and validating the indicator. We demonstrate that contraceptive autonomy can be measured at the population level but a number of complex measurement challenges remain. Rather than a final validated tool, we consider this a step on a long road toward a more person-centered measurement agenda for the global family planning community.
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Affiliation(s)
- Leigh Senderowicz
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Pascal Zabré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
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14
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Bingenheimer JB, Hardee K, Hindin M, Jain A, Mumah J, Dam JV. Introduction to the Special Issue: Indicators in Sexual and Reproductive Health and Rights. Stud Fam Plann 2023; 54:9-16. [PMID: 36939037 DOI: 10.1111/sifp.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
| | | | | | - Aparna Jain
- Senior Director, Making Cents International & Chief of Party, CARE-GBV
| | - Joyce Mumah
- Technical Lead, Monitoring and Evaluation - WISH2ACTION, International Planned Parenthood Federation
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15
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Acre VN, Dijkerman S, Calhoun LM, Speizer IS, Poss C, Nyamato E. The association of quality contraceptive counseling measures with postabortion contraceptive method acceptance and choice: results from client exit interviews across eight countries. BMC Health Serv Res 2022; 22:1519. [PMID: 36514040 PMCID: PMC9749205 DOI: 10.1186/s12913-022-08851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client's perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients.
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Affiliation(s)
| | | | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Bingenheimer JB. Editor's Farewell. Stud Fam Plann 2022; 53:571-573. [PMID: 36477759 DOI: 10.1111/sifp.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Tumlinson K, Britton LE, Williams CR, Wambua DM, Onyango DO, Senderowicz L. Provider verbal disrespect in the provision of family planning in public-sector facilities in Western Kenya. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100178. [PMID: 36561124 PMCID: PMC9770586 DOI: 10.1016/j.ssmqr.2022.100178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Public-sector healthcare providers in low- and middle-income countries are a primary source of family planning but their disrespectful (i.e., demeaning or insulting) treatment of family planning clients may impede free contraceptive choice. The construct of disrespect and abuse has been widely applied to similar phenomena in maternity care and could help to better understand provider mistreatment of family planning clients. With a focus on public-sector family planning provision in western Kenya, we aim to estimate the prevalence and impact of disrespect and abuse from a variety of perspectives and advance methodological approaches to measuring this construct in the context of family planning provision. We combine and triangulate data from a variety of sources across five counties in western Kenya, including 180 mystery clients, 253 third-party observations, eight focus group discussions, 19 key informant interviews, and two journey mapping workshops. Across both mystery client and third-party observations conducted in public-sector facilities in western Kenya, approximately one out of every ten family planning seekers was treated with disrespect by their provider. Family planning clients were frequently scolded for seeking family planning while unmarried or low parity, but mistreatment was not limited to women with these specific characteristics. Women were also insulted for such characteristics as body size or perceived sexual promiscuity. Qualitative data confirmed both that client disrespect is widespread and leads women to avoid family planning services even when they desire to use a contraceptive method, sometimes leading to unintended pregnancies. Key informants attribute disrespectful provider practices to both low technical skill as well as poor motivation stemming from both intrinsic values as well as extrinsic factors such as low wages and high caseloads. Possible solutions suggested by key informants included changes to recruitment and admission for Kenyan medical/nursing schools, as well as values clarification to shift provider motivations. Interventions to reduce mistreatment must be multi-layered and well-evidenced to ensure that family planning clients receive the person-centered care that enables them to achieve their contraceptive desires and reproductive freedom.
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Affiliation(s)
- Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | | | - Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | | | - Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Leigh Senderowicz
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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18
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Senderowicz L, Sokol N, Pearson E, Francis J, Ulenga N, Bärnighausen T. The effect of a postpartum intrauterine device programme on choice of contraceptive method in Tanzania: a secondary analysis of a cluster-randomized trial. Health Policy Plan 2022; 38:38-48. [PMID: 36330537 PMCID: PMC9849716 DOI: 10.1093/heapol/czac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/06/2022] Open
Abstract
Vertical global health programmes often evaluate success with a narrow focus on programmatic outcomes. However, evaluation of broader patient-centred and unintended outcomes is critical to assess impacts on patient choice and autonomy. Here, we evaluate the effects of a postpartum intrauterine device (PPIUD) intervention on outcomes related to contraceptive method choice. The stepped-wedge cluster randomized contolled trial (RCT) took place in five Tanzanian hospitals. Hospitals were randomized to receive immediate (Group 1; n = 11 483 participants) or delayed (Group 2; n = 8148 participants) intervention. The intervention trained providers on PPIUD insertion and counselling. The evaluation surveyed eligible women (18+, resided in Tanzania, gave birth at a study hospital) on provider postpartum contraceptive counselling during pregnancy or immediately postpartum. In our completed study, participants were considered exposed (n = 9786) or unexposed (n = 10 145) to the intervention based on the location and timing of their birth (no blinding). Our secondary analysis examined differences by intervention exposure on the likelihood of being counselled on IUD only, multiple methods, multiple method durations, a broad method mix; and on the number of methods women were counselled across two samples: all eligible women, and only women who reported receiving any contraceptive counselling. Among all eligible women, counselling on the IUD alone was 7% points higher among the exposed (95% confidence interal (CI): 0.02, 0.12). Among women who received any counselling, those exposed to the intervention were counselled on 1.12 fewer contraceptive methods (95% CI: 0.10, 2.34). The likelihood of receiving counselling on any non-IUD method decreased among those exposed, while the likelihood of being counselled on an IUD alone was 14% points higher among the exposed (95% CI: 0.06, 0.22), suggesting this intervention increased IUD-specific counselling but reduced informed contraceptive choice. These findings underscore the importance of broad metrics that capture autonomy and rights (in addition to programmatic goals) at all stages of health programme planning and implementation.
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Affiliation(s)
- Leigh Senderowicz
- *Corresponding author. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA. E-mail:
| | - Natasha Sokol
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main St., Providence, RI 02903, USA
| | - Erin Pearson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA,Department of Technical Excellence, Ipas, P.O. Box 9990, Chapel Hill, NC 27515, USA
| | - Joel Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Parktown, Johannesburg 2193, South Africa,Management and Development for Health, P.O Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, P.O Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA,Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3. Marsilius Arkaden—6. Stock, Heidelberg 69120, Germany
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19
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Onyango DO, Tumlinson K, Chung S, Bullington BW, Gakii C, Senderowicz L. Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya. BMC Public Health 2022; 22:1960. [PMID: 36280808 PMCID: PMC9592126 DOI: 10.1186/s12889-022-14388-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention-the Community Score Card (CSC)-in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision. METHODS We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics. RESULTS The involvement of community health volunteers and supportive community members - as well as the willingness of some providers to consider changes to their own behaviors-were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services. CONCLUSION Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC - or other social accountability efforts - can result in improved contraceptive access.
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Affiliation(s)
- Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya.
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands.
| | - Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephanie Chung
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brooke W Bullington
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Catherine Gakii
- Innovations for Poverty Action-Kenya (IPA-K), Nairobi, Kenya
| | - Leigh Senderowicz
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Adaptation of the Person-Centered Perioperative Nursing Scale to Turkish: A Validity and Reliability Analysis. J Perianesth Nurs 2022; 37:712-716. [DOI: 10.1016/j.jopan.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
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Speizer IS, Bremner J, Farid S. Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100450. [PMID: 35294385 PMCID: PMC8885354 DOI: 10.9745/ghsp-d-21-00450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
We examine current “need”-based family planning measures that are based on women’s fertility desires and contraceptive use, identify challenges with language and use of need-based measures, and recommend ways to improve language and measurement.
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Affiliation(s)
- Ilene S Speizer
- Department of Maternal and Child Health and Carolina Population Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | - Shiza Farid
- FP2030, Washington DC, USA
- Avenir Health, Washington, DC, USA
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22
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Aksu S, Aksoy M, Gurcuoglu E, Erenel A. Development and psychometric evaluation of the contraceptive attitude questionnaire. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_147_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Leslie HH, Sharma J, Mehrtash H, Berger BO, Irinyenikan TA, Balde MD, Mon NO, Maya E, Soumah AM, Adu-Bonsaffoh K, Maung TM, Bohren MA, Tunçalp Ö. Women's report of mistreatment during facility-based childbirth: validity and reliability of community survey measures. BMJ Glob Health 2021; 5:bmjgh-2020-004822. [PMID: 34362792 PMCID: PMC8353172 DOI: 10.1136/bmjgh-2020-004822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background Accountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO ‘How women are treated during facility-based childbirth’ community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain. Methods The cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions. Results 2672 women answered over 70 items on mistreatment during childbirth. Reliability exceeded 0.60 in all countries for items on poor rapport with healthcare workers and in three countries for items on failure to meet professional standards; brief scales generally showed high agreement with longer versions and correlation with dissatisfaction. Brief item sets were ≥85% sensitive in detecting mistreatment in each country, over 90% for domains of physical abuse and health system conditions and constraints. Conclusion Brief scales to measure two domains of mistreatment are largely comparable with longer versions and can be informative for these four distinct settings. Brief item sets efficiently captured prevalence of mistreatment in the five domains analysed; stigma items can be used and adapted in full. Item sets are suitable for confirmation by context and implementation to increase accountability and inform efforts to eliminate mistreatment during childbirth.
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Affiliation(s)
- Hannah Hogan Leslie
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA .,Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
| | - Jigyasa Sharma
- Chief Economist's Office, Human Development Group, World Bank Group, Washington, District of Columbia, USA
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Blair Olivia Berger
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Theresa Azonima Irinyenikan
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, Nigeria
| | - Mamadou Dioulde Balde
- Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Nwe Oo Mon
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Ernest Maya
- School of Public Health, University of Ghana, Accra, Ghana
| | - Anne-Marie Soumah
- Cellulle de Recherche en Sante de la Reproduction en Guinee (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
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24
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Bhan N, Raj A. From choice to agency in family planning services. Lancet 2021; 398:99-101. [PMID: 33971154 DOI: 10.1016/s0140-6736(21)00990-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Nandita Bhan
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA; Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, CA, USA
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25
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Qureshi Z, Mehrtash H, Kouanda S, Griffin S, Filippi V, Govule P, Thwin SS, Bello FA, Gadama L, Msusa AT, Idi N, Goufodji S, Kim CR, Wolomby-Molondo JJ, Mugerwa KY, Bique C, Adanu R, Fawole B, Madjadoum T, Gülmezoglu AM, Ganatra B, Tunçalp Ö. Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries. BMJ Glob Health 2021; 6:bmjgh-2020-003702. [PMID: 33514590 PMCID: PMC7845704 DOI: 10.1136/bmjgh-2020-003702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa. Methods A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications. Results There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%). Conclusion There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.
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Affiliation(s)
- Zahida Qureshi
- Department of Obstetrics and Gynaecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Seni Kouanda
- Institut de Recherche en Science de la Santé, Burkina Faso and Institut africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Sally Griffin
- Centro Internacional Para Saúde Reprodutiva (ICRH-M), Maputo, Mozambique
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Luis Gadama
- College of Medicine, Department of Obstetrics and Gynaecology, University of Malawi, Zomba, Malawi
| | - Ausbert Thoko Msusa
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nafiou Idi
- Université Abdou Moumouni de Niamey, Niamey, Niger
| | - Sourou Goufodji
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | | | - Cassimo Bique
- Mozambican Society of Obstetrician and Gynaecologists (AMOG), Maputo, Mozambique
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, University of Ibadan, Ibadan, Nigeria
| | | | - Ahmet Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Baum SE, Wilkins R, Wachira M, Gupta D, Dupte S, Ngugi P, Makleff S. Abortion quality of care from the client perspective: a qualitative study in India and Kenya. Health Policy Plan 2021; 36:1362-1370. [PMID: 34133733 PMCID: PMC8505864 DOI: 10.1093/heapol/czab065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/30/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Quality healthcare is a key part of people's right to health and dignity, yet access to high-quality care can be limited by legal, social and economic contexts. There is limited consensus on what domains constitute quality in abortion care and the opinions of people seeking abortion have little representation in current abortion quality measures. In this qualitative study, we conducted 45 interviews with abortion clients in Mumbai, India, and in Eldoret and Thika, Kenya, to assess experiences with abortion care, definitions of quality and priorities for high-quality abortion care. Among the many aspects of care that mattered to clients, the client-provider relationships emerged as essential. Clients prioritized being treated with kindness, respect and dignity; receiving information and counselling that was personalized to their individual situation and reassurance and support from their provider throughout the entire abortion process, including follow-up after the abortion. Many clients also noted the importance of skilled providers and appropriate care. There were similarities across the two country contexts, yet there were some differences in how clients defined high-quality care; therefore, specific political and cultural influences must be considered when implementing measurement and improving person-centred quality of care. These domains, particularly interpersonal interactions, should be prioritized in India and Kenya when health systems, facilities and providers design person-centred measures for quality in abortion care.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA 94612, USA
| | - Rebecca Wilkins
- International Planned Parenthood Federation, 4 Newhams Row, London SE1 3UZ, UK
| | - Muthoni Wachira
- International Planned Parenthood Federation/Africa Regional Office, Lenana/Galana Road Junction, PO Box 30234, Nairobi, Kenya
| | - Deepesh Gupta
- International Planned Parenthood Federation/South Asia Regional Office, 231 Okhla Industrial Estate, Phase-3, New Dehli-110020, India
| | - Shamala Dupte
- Family Planning Association of India, Nariman Point, Mumbai 400 021, India
| | - Peter Ngugi
- Family Health of Kenya, Mai Mahiu Road, Nairobi, Kenya
| | - Shelly Makleff
- Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA 94612, USA
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Dey AK, Averbach S, Dixit A, Chakraverty A, Dehingia N, Chandurkar D, Singh K, Choudhry V, Silverman JG, Raj A. Measuring quality of family planning counselling and its effects on uptake of contraceptives in public health facilities in Uttar Pradesh, India: A cross-sectional analysis. PLoS One 2021; 16:e0239565. [PMID: 33945555 PMCID: PMC8096066 DOI: 10.1371/journal.pone.0239565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Quality of care in family planning traditionally focuses on promoting awareness of the broad array of contraceptive options rather than on the quality of interpersonal communication offered by family planning (FP) providers. There is a growing emphasis on person-centered contraceptive counselling, care that is respectful and focuses on meeting the reproductive needs of a couple, rather than fertility regulation. Despite the increasing global focus on person-centered care, little is known about the quality of FP care provided in low- and middle- income countries like India. This study involves the development and psychometric testing of a Quality of Family Planning Counselling (QFPC) measure, and assessment of its associations with contraceptives selected by clients subsequently. METHODS We analyzed cross-sectional survey data from N = 237 women following their FP counselling in 120 public health facilities (District Hospitals and Community Health Centers) sampled across the state of Uttar Pradesh in India. The study captured QFPC, contraceptives selected by clients post-counselling, as well as client and provider characteristics. Based on formative research and using Principal Component Analysis, we developed a 13-item measure of quality of FP counselling. We used adjusted regression models to assess the association between QFPC and contraceptive selected post-counselling. RESULTS The QFPC measure demonstrated good internal reliability (Cronbach alpha = 0.80) as well as criterion validity, as indicated by client reports of high QFPC being significantly more likely for clients with trained versus untrained counsellors. We found that each point increase in QFPC, including increasing quality of counselling, is associated with higher odds of clients selecting an intrauterine device (IUD) (aRR:1.03; 95% CI:1.01-1.05) and sterilization (aRR:1.06; 95% CI:1.03-1.08), compared to no method selected. CONCLUSIONS High-quality FP counselling is associated with clients subsequently selecting more effective contraceptives, including IUD and sterilization, in India. High-quality counselling is also more likely among FP-trained providers, highlighting the need for focused training and monitoring of quality care. TRIAL REGISTRATION CTRI/2015/09/006219. Registered 28 September 2015.
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Affiliation(s)
- Arnab K. Dey
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
- * E-mail:
| | - Sarah Averbach
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Anvita Dixit
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | - Amit Chakraverty
- Sambodhi Research and Communications, Noida, Uttar Pradesh, India
| | - Nabamallika Dehingia
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | | | - Kultar Singh
- Sambodhi Research and Communications, Noida, Uttar Pradesh, India
| | - Vikas Choudhry
- Sambodhi Research and Communications, Noida, Uttar Pradesh, India
| | - Jay G. Silverman
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Anita Raj
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi. BMC Health Serv Res 2021; 21:336. [PMID: 33853581 PMCID: PMC8045277 DOI: 10.1186/s12913-021-06353-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi. Methods We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes. Results Some SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found. Conclusions We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06353-z.
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Blanc AK, McCarthy KJ, Warren C, Bajracharya A, Bellows B. The Validity of Women's Reports of Family Planning Service Quality in Cambodia and Kenya. Stud Fam Plann 2021; 52:77-93. [PMID: 33724485 DOI: 10.1111/sifp.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Population-based indicators of the coverage of key elements of high-quality family planning services are tracked via household surveys with female respondents, yet little work has been done to establish their validity. We take advantage of existing data sets from Cambodia and Kenya to compare women's responses at exit interviews following a health facility visit against the observations of a trained third-party observer during the visit. The results, which treat the observations as the reference standard, show that indicators that measure contraceptive methods received are accurately reported while indicators of whether the woman received her preferred method and whether information was "discussed" or "explained" during counseling are less reliably reported. Studies designed explicitly to assess the validity of family planning questions in household surveys, especially questions in large survey programs critical for monitoring demographic trends and programmatic coverage, are needed.
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Affiliation(s)
- Ann K Blanc
- Population Council, 1 Dag Hammarksjold Plaza, New York, NY, 10017
| | | | - Charlotte Warren
- Population Council, 4301 Connecticut Avenue NW, Suite 280, Washington, DC, 20008
| | - Ashish Bajracharya
- Population Council, House #12, Road #25/30, Gulshan-1, Dhaka, 1212, Bangladesh
| | - Benjamin Bellows
- Population Council, 4301 Connecticut Avenue NW, Suite 280, Washington, DC, 20008
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30
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Cotter SY, Sudhinaraset M, Phillips B, Seefeld CA, Mugwanga Z, Golub G, Ikiugu E. Person-centred care for abortion services in private facilities to improve women's experiences in Kenya. CULTURE, HEALTH & SEXUALITY 2021; 23:224-239. [PMID: 32105189 DOI: 10.1080/13691058.2019.1701083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/17/2019] [Indexed: 06/10/2023]
Abstract
Globally, access to good quality abortion services and post-abortion care is a critical determinant for women's survival after unsafe abortion. Unsafe abortions account for high levels of maternal death in Kenya. We explored women's experiences and perceptions of their abortion and post-abortion care experiences in Kenya through person-centred care. This qualitative study included focus group discussions and in-depth interviews with women aged 18-35 who received safe abortion services at private clinics. Through thematic analyses of women's testimonies, we identified gaps in the abortion care and person-centred domains which seemed to be important throughout the abortion process. When women received clear communication and personalised comprehensive information on abortion and post-abortion care from their healthcare providers, they reported more positive experiences overall and higher reproductive autonomy. Communication and supportive care were particularly valued during the post-abortion period, as was social support more generally. Further research is needed to design, implement and test the feasibility and acceptability of person-centred abortion care interventions in community and clinical settings with the goal of improving women's abortion experiences and overall reproductive health outcomes.
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Affiliation(s)
- Sun Yu Cotter
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - May Sudhinaraset
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Diamond-Smith N, McDonell C, Sahu AB, Roy KP, Giessler K. A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India. BMC Health Serv Res 2020; 20:1139. [PMID: 33308230 PMCID: PMC7733295 DOI: 10.1186/s12913-020-05995-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05995-9.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - Claire McDonell
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Ananta Basudev Sahu
- Population Services International, C-445, Bipin Chandra Pal Marg, Block C, Chittaranjan, New Delhi, Delhi, 110019, India
| | - Kali Prasad Roy
- Population Services International, C-445, Bipin Chandra Pal Marg, Block C, Chittaranjan, New Delhi, Delhi, 110019, India
| | - Katie Giessler
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
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Sudhinaraset M, Landrian A, Afulani PA, Phillips B, Diamond-Smith N, Cotter S. Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya. BMC WOMENS HEALTH 2020; 20:208. [PMID: 32950052 PMCID: PMC7501655 DOI: 10.1186/s12905-020-01071-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
Background There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. Methods Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity. Results We developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability. Conclusions This validated scale will facilitate measurement and further research to better understand women’s experiences during abortion care and to improve the quality of women’s overall reproductive health experiences to improve health outcomes.
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Affiliation(s)
- May Sudhinaraset
- Community Health Sciences, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 650 Charles E Young Dr. S, Los Angeles, CA, USA
| | - Amanda Landrian
- Community Health Sciences, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 650 Charles E Young Dr. S, Los Angeles, CA, USA.
| | - Patience A Afulani
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
| | - Sun Cotter
- Institute for Global Health Sciences, University of California, San Francisco, School of Medicine, 550 16th Street, San Francisco, CA, USA
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Johns NE, Dixit A, Ghule M, Begum S, Battala M, Kully G, Silverman J, Dehlendorf C, Raj A, Averbach S. Validation of the Interpersonal Quality of Family Planning Scale in a rural Indian setting. Contracept X 2020; 2:100035. [PMID: 32793878 PMCID: PMC7416338 DOI: 10.1016/j.conx.2020.100035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The provision of high-quality family planning (FP) counseling can both enhance clients' experience of care and improve their ability to make and act on their contraceptive decisions. The Interpersonal Quality of Family Planning (IQFP) scale measures FP counseling quality and has been validated in the United States. We aimed to explore whether it remains appropriate for use in a low-/middle-income country (LMIC). Study design We surveyed 1201 nonsterilized married women ages 18-29 in Maharashtra, India, between September 2018 and June 2019. Respondents rated their FP provider from "poor" (1) to "excellent" (5) across 11 IQFP items. We assessed scale reliability via Cronbach's α test and used exploratory factor analysis to evaluate unidimensionality and regression models of plausibly related outcomes to assess construct validity. Results Five hundred four women (42%) had seen an FP provider within the past year, 491 (97%) of whom answered all items. Mean IQFP score was 2.62 out of 5 (SD 0.94, range 1-5). Scale reliability was high (α = 0.97). Exploratory factor analyses support unidimensionality (all factor loadings > 0.4). A 1-point increase in average IQFP score was associated with nearly double the odds of current modern contraceptive use (adjusted odds ratio = 1.73, 95% confidence interval = 1.36-2.19). Conclusions The IQFP scale shows good reliability and construct validity in this context, and its use in LMIC settings should be broadly considered. A higher IQFP score was associated with greater odds of contraceptive use. The reported FP counseling quality was low, so future public health efforts should aim to increase counseling quality to better meet the needs of women in low-resource settings like rural India. Measurement tools like IQFP can support success evaluation of the quality of care provided by family planning programs. Implications The Interpersonal Quality of Family Planning scale is a useful tool in rural India, a different context than the one in which it was developed. Use of the IQFP scale should be considered in other low-/middle-income countries to better measure the quality of family planning care provided.
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Affiliation(s)
- Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive Health, J.M. Street, Parel, Mumbai, 400012, India
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor, India Habitat Center, Lodi Road, New Delhi, 110003, India
| | - Gennifer Kully
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Department of Family & Community Medicine, University of California, San Francisco, 995 Portero Avenue, San Francisco, CA, 94110, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, 9300 Campus Point Drive #7433, La Jolla, CA, 92037, USA
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Diamond-Smith N, Giessler K, Munson M, Green C. Do quality improvement interventions for person-centered family planning work? Evidence from Kenya. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13120.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Quality of care for family planning, especially person-centered care, is important from a health and human-rights standpoint. Few interventions have aimed to improve person-centered family planning (PCFP) in low and middle-income countries. In this study, we tested the impact of a quality improvement (QI) intervention in Kenya on aspects of PCFP included in a validated measure of PCFP and on the overall PCFP scale. Methods: We conducted QI cycles in three facilities providing family planning in Nairobi and Kiambu Counties, Kenya, with three facilities serving as controls. Cross-sectional baseline data was collected from 478 women receiving family planning in 2016 and end line data was collected from 640 in 2017-18. We analysed the impact of the QI intervention on PCFP using difference-in-difference models. Results: We found no impact of the QI intervention on either PCFP or the overall PCFP scale. Conclusions: We take away key lessons learned from the null findings of the intervention that are important for future interventions. Lessons learned include the need to be flexible in light of external factors that prolonged the study and probably led to burnout; and simplifying measurement and procedures.
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Feeser K, Chakraborty NM, Calhoun L, Speizer IS. Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya. Gates Open Res 2020; 3:1453. [PMID: 32140663 PMCID: PMC7042708 DOI: 10.12688/gatesopenres.12974.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined - the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. Results: A woman's likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.
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Affiliation(s)
- Karla Feeser
- Metrics for Management, Baltimore, MD, 21201, USA
| | | | - Lisa Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | - Ilene S Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
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Dehingia N, Dixit A, Averbach S, Choudhry V, Dey A, Chandurkar D, Nanda P, Silverman JG, Raj A. Family planning counseling and its associations with modern contraceptive use, initiation, and continuation in rural Uttar Pradesh, India. Reprod Health 2019; 16:178. [PMID: 31831034 PMCID: PMC6909586 DOI: 10.1186/s12978-019-0844-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background We examine the association between the quality of family planning (FP) counseling received in past 24 months, and current modern contraceptive use, initiation, and continuation, among a sample of women in rural Uttar Pradesh, India. Methods This study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15–49 years; the analysis excluded women who were already using a permanent method of contraceptive during the first round of survey and who reported discontinuation because they wanted to be pregnant (N = 1398). We measured quality of FP counseling using four items on whether women were informed of advantages and disadvantages of different methods, were told of method(s) that are appropriate for them, whether their questions were answered, and whether they perceived the counseling to be helpful. Positive responses to every item was categorized as higher quality counseling, vs lower quality counseling for positive response to less than four items. Outcome variables included modern contraceptive use during the second round of survey, and a variable categorizing women based on their contraceptive use behavior during the two rounds: continued-users, new-users, discontinued-users, and non-users. Results Around 22% had received any FP counseling; only 4% received higher-quality counseling. Those who received lower-quality FP counseling had 2.42x the odds of reporting current use of any modern contraceptive method (95% CI: 1.56–3.76), and those who received higher quality FP counseling at 4.14x the odds of reporting modern contraceptive use (95% CI: 1.72–9.99), as compared to women reporting no FP counseling. Women receiving higher-quality counseling also had higher likelihood of continued use (ARRR 5.93; 95% CI: 1.97–17.83), as well as new use or initiation (ARRR: 4.2; 95% CI: 1.44–12.35) of modern contraceptives. Receipt of lower-quality counseling also showed statistically significant associations with continued and new use of modern contraceptives, but the effect sizes were smaller than those for higher-quality counseling. Conclusions Findings suggest the value of FP counseling. With a patient-centered approach to counseling, continued use of modern contraceptives can be supported among married women of reproductive age. Unfortunately, FP counseling, particularly higher-quality FP counseling remains rare.
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Affiliation(s)
- Nabamallika Dehingia
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. .,Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, USA.
| | - Anvita Dixit
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.,Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Department of Reproductive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Vikas Choudhry
- Sambodhi Research and Communications Pvt. Ltd., Noida, India
| | - Arnab Dey
- Sambodhi Research and Communications Pvt. Ltd., Noida, India
| | | | - Priya Nanda
- Bill and Melinda Gates Foundation, New Delhi, Delhi, India
| | - Jay G Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
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Sudhinaraset M, Landrian A, Montagu D, Mugwanga Z. Is there a difference in women's experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services. PLoS One 2019; 14:e0225333. [PMID: 31765417 PMCID: PMC6876888 DOI: 10.1371/journal.pone.0225333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022] Open
Abstract
Little evidence exists on women's experiences of care during abortion care, partly due to limitations in existing measures. Moreover, globally, the development and rapid growth in the availability of medication abortions (MA) has radically changed the options for safe abortions for women. It is therefore important to understand how women's experiences of care may differ across medication and manual vacuum aspiration (MVA) abortions. This study uses a validated person-centered abortion care scale (categorized as low, medium, and high levels, with high levels representing the greatest level of person-centered care) to assess women's experiences of care undergoing medication abortions vs. MVA. This paper reports on a cross-sectional study of 353 women undergoing abortions at one of six family planning clinics in Nairobi County, Kenya in 2018. Comparing abortion types, we found that the MVA sample was more likely to report "high" levels of person-centered abortion care compared to the MA sample (36.3% vs. 23.0%, p = 0.005). No differences were detected with respect to Respectful and Supportive Care; however, the MVA sample was significantly more likely to report "high" levels of Communication and Autonomy compared to the MA sample (23.6% vs. 11.2%, p<0.0001). In multivariable ordered logistic regression, we found that the MVA sample had a 92% greater likelihood of reporting higher person-centered abortion care scores compared to MA clients (aOR1.92, CI: 1.17-3.17). Being employed and reporting higher self-rated health were associated with higher person-centered abortion care scores, while reporting higher levels of stigma were associated with lower person-centered abortion care scores. Our findings suggest that more efforts are needed to improve the domain of Communication and Autonomy, particularly for MA clients.
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Affiliation(s)
- May Sudhinaraset
- Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Amanda Landrian
- Community Health Sciences, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Dominic Montagu
- Institute for Global Health Sciences, University of California San Francisco, School of Medicine, San Francisco, CA, United States of America
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Senderowicz L. "I was obligated to accept": A qualitative exploration of contraceptive coercion. Soc Sci Med 2019; 239:112531. [PMID: 31513932 DOI: 10.1016/j.socscimed.2019.112531] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 01/18/2023]
Abstract
Despite narratives about empowering women through contraception, global family planning programs are evaluated primarily by their ability to increase contraceptive uptake and reduce fertility in the developing world. Some scholars have raised concerns that this emphasis on fertility reduction and contraceptive uptake may contribute to situations where women are coerced into adopting contraceptive services they do not fully understand or want. Yet surprisingly little data have been collected to investigate whether such coercion exists or how it might manifest. In-depth interviews with 49 women of reproductive age in a sub-Saharan African country begin to fill this knowledge gap. Respondents reported a range of non-autonomous experiences including biased or directive counseling, dramatically limited contraceptive method mix, scare tactics, provision of false medical information, refusal to remove provider-dependent methods, and the non-consented provision of long-acting methods. The results show that, rather than a binary outcome, coercion sits on a spectrum and need not involve overt force or violence, but can also result from more quotidian limits to free, full, and informed choice. The study finds that global family planning policies and discourses do appear to incentivize coercive practices. It also calls into question the central role of intentionality, by demonstrating how coercion can arise from structural causes as well as interpersonal ones. By showing how contraceptive autonomy may be limited even by providers working in good faith, these results argue for an end to the instrumentalization of women's bodies, and for a radical reconceptualization of family planning goals and measurements to focus exclusively on reproductive health, rights and justice.
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Affiliation(s)
- Leigh Senderowicz
- Harvard University T.H. Chan School of Public Health, Department of Global Health and Population, 677 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA.
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Cole MS, Boydell V, Hardee K, Bellows B. The Extent to Which Performance-Based Financing Programs' Operations Manuals Reflect Rights-Based Principles: Implications for Family Planning Services. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:329-339. [PMID: 31249026 PMCID: PMC6641818 DOI: 10.9745/ghsp-d-19-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/03/2019] [Indexed: 11/24/2022]
Abstract
Rights principles should be prioritized and more clearly stated in performance-based financing (PBF) guidance and operational documents. Additional research, including development of validated measurement metrics, is needed to help PBF programs systematically align with rights-based approaches to health care including family planning. Recognition is growing that development programs need to be guided by rights as well as to promote, protect, and fulfill them. Drawing from a content analysis of performance-based financing (PBF) implementation manuals, we quantify the extent to which these manuals use a rights perspective to frame family planning services. PBF is an adaptable service purchasing strategy that aims to improve equity and quality of health service provision. PBF can contribute toward achieving global family planning goals and has institutional support from multiple development partners including the Global Financing Facility in support of Every Woman Every Child. A review of 23 PBF implementation manuals finds that all documents are focused largely on the implementation of quality and accountability mechanisms, but few address issues of accessibility, availability, informed choice, acceptability, and/or nondiscrimination and equity. Notably, operational inclusion of agency, autonomy, empowerment, and/or voluntarism of health care clients is absent. Based on these findings, we argue that current PBF programs incorporate some mention of rights but are not systematically aligned with a rights-based approach. If PBF programs better reflected the importance of client-centered, rights-based programming, program performance could be improved and risk of infringing rights could be reduced. Given the mixed evidence for PBF benefits and the risk of perverse incentives in earlier PBF programs that were not aligned with rights-based approaches, we argue that greater attention to the rights principles of acceptability, accessibility, availability, and quality; accountability; agency and empowerment; equity and nondiscrimination; informed choice and decision making; participation; and privacy and confidentiality would improve health service delivery and health system performance for all stakeholders with clients at the center. Based on this review, we recommend making the rights-based approach explicit in PBF; progressively operationalizing rights, drawing from local experience; validating rights-based metrics to address measurement gaps; and recognizing the economic value of aligning PBF with rights principles. Such recommendations anchor an aspirational rights agenda with a practical PBF strategy on the need and opportunity for validated metrics.
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Holt K, Zavala I, Quintero X, Hessler D, Langer A. Development and Validation of the Client-Reported Quality of Contraceptive Counseling Scale to Measure Quality and Fulfillment of Rights in Family Planning Programs. Stud Fam Plann 2019; 50:137-158. [PMID: 31120147 PMCID: PMC6618078 DOI: 10.1111/sifp.12092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We developed the Quality of Contraceptive Counseling (QCC) Scale to improve measurement of client experiences with providers in the era of rights‐based service delivery. We generated scale items drawing on the previously published QCC Framework and qualitative research on women's preferences for counseling in Mexico, and refined them through cognitive interviews (n = 29) in two Mexican states. The item pool was reduced from 35 to 22 items after pilot testing using exit interviews in San Luis Potosí (n = 257). Exploratory Factor Analysis revealed three underlying dimensions (Information Exchange, Interpersonal Relationship, Disrespect and Abuse); this dimensionality was reproduced in Mexico City (n = 242) using Confirmatory Factor Analysis. Item Response Theory analyses confirmed acceptable item properties in both states, and correlation analyses established convergent, predictive, and divergent validity. The QCC Scale and subscales fill a gap in measurement tools for ensuring high quality of care and fulfillment of human rights in contraceptive services, and should be evaluated and adapted in other contexts.
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Feeser K, Chakraborty NM, Calhoun L, Speizer IS. Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya. Gates Open Res 2019; 3:1453. [DOI: 10.12688/gatesopenres.12974.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need in five cities in Kenya. Two measures of FPQ are examined – the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. Results: A woman’s likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). Facility-level MII was correlated with overall facility quality (R= 0.3197, p < 0.05). Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.
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