Quality of care in family planning services in rural Mozambique with a focus on long acting reversible contraceptives: a cross-sectional survey

Level of client satisfaction among family planning service users in semi-pastoralist areas of Southeast Ethiopia: a mixed-methods study

Background

Client satisfaction with family planning services is a crucial metric for gauging healthcare providers' performance. There is a dearth of local data that explores the factors that influence clients' satisfaction with family planning services in semi-pastoral areas using a mixed-methods approach. This study aimed to assess the level of client satisfaction and its associated factors among family planning service users in six public health centers in Southeast Ethiopia.

Methods

A multi-centered, concurrent, mixed-method survey using quantitative and qualitative methods was conducted in six public health centers in Southeast Ethiopia from March 15 to April 16, 2022. Four hundred nineteen systematically selected family planning method users and their respective six family planning service providers were approached using a purposive sampling technique. A multivariable binary logistic regression model was used to identify the independent factors associated with clients' satisfaction with family planning services.

Results

Four hundred fourteen study participants were finally approached, and client satisfaction with family planning services in those centers was 57.5% with a 95% CI of 52.71%-62.71%. Being in the age group of 25-34 years (AOR = 1.99; 95% CI 1.2, 3.29), married (AOR = 2.41; 95% CI 1.13, 5.15), waiting less than 30 min (AOR = 1.74; 95% CI 1.11, 2.72), and receiving the family planning method they want (AOR = 2.35; 95% CI 1.16, 4.76) were positively associated with client satisfaction. Updating the provider's skills and knowledge, keeping clients' method choices, and leaving free decisions also increased client satisfaction.

Conclusions

In this study, client satisfaction with family planning services remains low. Users' age, marital status, waiting time, and wish to receive the method they want were positively associated with client satisfaction.

Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa

BACKGROUND

Improving women's access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women's receipt of quality contraceptive counselling and its associated factors in SSA.

METHODS

Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling.

RESULTS

Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20-24 (AOR = 1.48, CI: 1.32-1.67), those with primary (AOR = 1.32, CI: 1.11-1.57) and secondary or higher education (AOR = 1.31, CI: 1.09-1.58), and those married (AOR = 1.32, CI: 1.15-1.52), cohabiting (AOR = 1.47, CI: 1.23-1.76), and previously married (AOR = 1.48, CI: 1.20-1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09-1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21-1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52-1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86-6.51), Eastern (AOR = 2.54, CI: 1.96-3.30), and Western (AOR = 4.09, CI: 3.19-5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups.

CONCLUSION

Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women's access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women's access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.

The effect of integration of family planning education with infant vaccination visits on the uptake of postpartum family planning in Ile-Ife, Nigeria

Integration of maternal and child health services can improve service utilisation. An operations research was conducted in a Nigerian tertiary hospital. A pilot study was conducted at three family planning (FP) and vaccination sites. A formative assessment was carried out using client records and key-informant interviews. Pre- and post-integration questionnaires were administered to 715 women attending the infant vaccination clinics. Themes were developed from the qualitative data and some verbatim quotes were reported. The quantitative data were analysed using Stata, version 17. Univariate and multivariate analyses were done to compare associations between categorical independent and outcome variables where applicable, with level of significance set at <0.05 and 95% confidence interval.The health care workers were willing to integrate the two services but inadequate training and time constraint were key barriers. Significant increases in the knowledge of contraception (25.7% vs 34.7%, p = 0.001), intention to use contraception (31.2% vs 38.2%, p = 0.001), and number of new acceptors of FP (487 vs 664, p = 0.001), were recorded post-integration, even though it was difficult to determine whether the observed increase in new FP acceptors was due to increased patronage from the study participants and not from other clients who were not part of the study. Integration of FP education and infant vaccination services is a feasible and acceptable strategy for increasing contraceptive use among postpartum women, as vaccination clinic staff were willing to take on FP education along with their current duties.Impact statementWhat is already known on this subject? Few studies have reported on the outcomes related to FP and vaccination integration.What the results of this study add? A simple model of FP education and infant vaccination services integration is a feasible and acceptable strategy for increasing contraceptive use among postpartum women. However, inadequate training and time constraint were major concerns for healthcare providers.Implications of these findings for clinical practice and/or further research? Targeted family planning education and referral should be encouraged during infant vaccination visits. There is a need for further research to determine the providers' skills necessary for integration and whether integration poses a risk to either service.

Quality of family planning services and associated factors among reproductive age women attending family planning unit at public health facilities in Dire Dawa, Eastern Ethiopia, 2021

INTRODUCTION

Improving the quality of care has been a necessary goal for family planning programs worldwide. Even though extensive work has been done, the contraceptive prevalence rate is still low (41% in Ethiopia, 30.5% in Dire Dawa) and the unmet need for contraception is high (26%) in Ethiopia. Moreover, quality of care in family planning services has an important role in increasing coverage of services and program sustainability. Therefore, the objective of this study was to assess quality of family planning services and associated factors among reproductive age women attending family planning unit in public health facilities in Dire Dawa, Eastern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among reproductive-age women attending a family planning unit in Dire Dawa, Eastern Ethiopia, from September 1-30/2021. A total of 576 clients were selected by systematic random sampling and interviewed using a pre-tested structured questionnaire. SPSS version 24 was used to analyze the data, which included descriptive statistics, bi-variable and multivariable logistic regression analyses. To determine the presence of an association between dependent and independent variables, AOR, P-value 0.05, and 95% CI were used.

RESULTS

A total of 576 clients participated in the study and provided a response rate of 99%. The overall satisfaction of clients with FP services was 79%[95% CI:75.2%, 82.9%]. Having primary education (AOR = 2.11, 95% CI(1.11-4.24), convenient facility opening hours (AOR = 3.13, 95% CI (2.12-5.75), maintaining privacy (AOR = 4.1, 95% CI(2.50-8.12), demonstrating how to use F/P method (AOR = 1.98, 95% CI (1.01-5.20), and discussing F/P issues with husbands (AOR = 5.05, 95% CI: 3.33-7.64) were positively significantly associated with client satisfaction.

CONCLUSION AND RECOMMENDATION

This study revealed that about four-fifth of the clients was satisfied with the service they received. Clients' education, facility opening hour, maintained privacy, discussion with husband, and demonstration of how to use the methods were associated with client satisfaction. Therefore, health facility heads should improve facility opening hour. Health care providers should maintain client privacy every time, and should consistently utilize information, education, and communication materials during consultation sessions by giving more attention to client who has no education. Partner's discussion on family planning issues should also be encouraged.

Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey

BACKGROUND

The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country.

METHODS

We analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Participants were young women aged 15-24 years, who were using a family planning method (n = 1,506). Good quality family planning counselling was defined a composite variable that included; a woman being told about side effects, how to deal with side effects, and the availability of other family planning methods/options. Logistic regression was performed using SPSS software version 25.

RESULTS

Out of 1,506 young women, 955 (63.4%, 95% CI: 60.5-65.3) received good quality family planning counselling services. Of the 36.6% that received inadequate counselling, 17.1% received no counselling at all. Good quality family planning counselling services was positively associated with receiving family planning services from government health facilities (aOR: 2.50, 95% CI: 1.83-3.41), having no major challenges with distance to access healthcare (aOR: 1.45, 95% CI: 1.10-1.90), having visited a health facility (AOR: 1.93, 95% CI: 1.45-2.58), and having been visited by a health field worker within the last 12 months (aOR: 1.67, 95% CI: 1.24-2.26) while residing in the southern region ( aOR: 0.39, 95% CI: 0.22-0.69) and belonging to the richest wealth quintile (aOR: 0.49, 95% CI: 0.24-0.98) were associated with less odds of receiving good quality family planning counselling services.

CONCLUSION

About 37% of the young women in Sierra Leone do not receive good quality family planning counselling services of which 17.1% received none. Based on the study's findings, it is important to emphasize the need to ensure that all young women have access to proper counselling services especially for those receiving these services from private health units, from the southern region and richest wealth quintile. Ensuring easier access through increasing affordable and friendly access points and strengthening field health workers' capacity in providing family planning services could also help improve access to good quality family planning services.

Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia

Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers’ and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.

Determinants of unmet need for family planning in Gambia & Mozambique: implications for women's health

Background

In low-middle-income countries, unmet need for family planning (FP) constitutes a major challenge for prevention of unintended pregnancies and associated health and psychological morbidities for women. The factors associated with unmet need for family planning have been studied for several countries in sub-Saharan Africa, but not much is known about the situation in Gambia and Mozambique. The purpose of this study was to perform a comparative analysis of the prevalence of unmet need for FP, and its sociodemographic correlates in Gambia and Mozambique to better inform FP policies and programs aimed at reducing associated negative health outcomes for women and their families.

Methods

In this analysis we used nationally representative data from Demographic and Health Surveys in Gambia (2013) and Mozambique (2011). Sample population were 23,978 women (n = 10,037 for Gambia and 13,745 for Mozambique) aged 15–49 years. Women who want to stop or delay childbearing but were not using any contraceptive method were considered to have unmet need for FP. Association between unmet need for FP and the explanatory variables was measured using binary logistic regression models

Results

Prevalence of unmet need for FP was 17.86% and 20.79% for Gambia and Mozambique, respectively. Having employment in professional/technical/managerial position showed an inverse association with unmet need both in Gambia [OR = 0.843, 95% CI 0.730, 0.974] and Mozambique [OR = 0.886, 95% CI 0.786, 0.999]. Education and household wealth level did not show any significant association with unmet need. The only positive association was observed for rural [OR = 1.213, 95% CI 1.022, 1.441] women in the richer households in Gambia. Having access to electronic media [OR = 0.698, 95% CI 0.582, 0.835] showed a negative effect on having unmet need in Mozambique. Women from female headed households in Gambia [OR = 0.780, 95% CI 0.617, 0.986] and Mozambique [OR = 0.865, 95% CI 0.768, 0.973] had lower odds of unmet need for FP.

Conclusion

The situation of unmet need for FP in Gambia and Mozambique was better than the Sub-Saharan African average (25%). Nonetheless, there is room for improvement in both countries. Significant assocations with lower unmet need for family planning and women’s occupational status (more education & higher skilled employment), access to mass media communication, and female-headed households provide possible areas for intervention for improved FP opportunities in the region.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01267-8.

Femiject, a once-a-month combined injectable contraceptive: experience from Pakistan

OBJECTIVES

The aims of the study were to compare the 12 month continuation rate, level of satisfaction and bleeding patterns of a once-a-month combined injectable contraceptive (CIC; Femiject), a 3 monthly progestogen-only injectable contraceptive (depot medroxyprogesterone acetate [DMPA]) and combined oral contraceptives (COCs).

METHODS

A prospective observational study was conducted at Aziz Medical Centre, Karachi, Pakistan. The study comprised 171 married women aged 19-35 years and requesting contraception. Participants were offered injectable contraceptives or COCs and evaluated twice: once at the beginning of the study and again after 12 months, or earlier if they discontinued use.

RESULTS

Sixty (35.1%) women chose COCs, 53 (31.0%) chose DMPA and 58 (33.9%) chose the CIC. The continuation rate was higher among CIC users (p = .034). CIC users were more satisfied with their method compared with those who chose COCs or DMPA (63.8% vs 25.0% and 28.3%, respectively). Most CIC users said they were likely or very likely to use the method again (63.8%); only 25.9% said they would not recommend it to a friend. CIC users had, however, more spotting compared with COC users (60.3% vs 3.3%; p ˂ .001).

CONCLUSION

As the continuation rate, level of satisfaction and bleeding profile of CIC users was promising, increased uptake should be encouraged. Our study shows that CIC is a good option for women requesting contraception.

Assessment of Family Planning Counseling Provided for Postpartum Women and Associated Factors

Background

Good quality family planning counseling particularly in the postpartum period is paramount to contraception adoption and continuation; it is also paramount in the reduction of maternal as well as infant morbidity and mortality.

Objective

Assess the level of family planning counseling provided for women in their immediate postpartum period in the labor ward at Saint Paul's Hospital in 2019.

Method

An institution-based cross-sectional study was conducted from February to March of 2019 among women in the labor ward. A face-to-face exit interview was conducted with 209 randomly selected women. A structured pretested questionnaire was used to assess the level of family planning counseling provided. Bivariate logistic regression was used to test for statistical association.

Results

Only 28.2% of the counseling sessions were adequate. Most (58.9%) of the counseling sessions did not maintain the privacy of the client. In 67.9% of the sessions, the counselor did not ask the concern of the client regarding the use of modern family planning methods and 74.2% of the clients were not told about the possible side effects of a method. Clients with no formal education (OR = 2.52, 95%CI = 1.1‐3.3) and those with only primary level education (OR = 1.22, 95%CI = 1.04‐3.02) were more likely to have had inadequate counseling.

Conclusion

The level of family planning counseling was inadequate. The study indicated the need to provide training for service providers on family planning counseling with the existing standard frameworks but also in consideration of the sociodemographic background of the client, particularly their educational status.