Investigating the quality of family planning counselling as part of routine antenatal care and its effect on intended postpartum contraceptive method choice among women in Nepal

Abstract

Background: Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women's perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision. Methods: In-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically. Results: Overall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling. Conclusions: There is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women's needs.

Missed opportunity for family planning counselling along the continuum of care in Arusha region, Tanzania

“…These findings imply that 60% of the women missed FP counselling when they visited the facility for any health reason; while 31.2% and 26.4% missed FP counselling at ANC and post-natal care (PNC) visits respectively. Similarly findings have been reported elsewhere [8,14,16,18,24]. Kanyangara et al reported a 6% missed opportunity of FP counselling in sub-Saharan country sites.…”

Lina Haryani, Relationship between knowledge and attitudes of third trimester pregnant women with iud contraception selection after childbirth

“…Therefore, women with higher education levels can increase women's knowledge about contraceptive use. In addition, these findings indicate that education has a positive impact on women's willingness to use the IUD after delivery (Puri, Moroni, et al, 2020).…”

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

“…These settings provide safe and acceptable opportunities to improve IPP LARC access and prevent RRP. 75,76 Community-based programs may address knowledge gaps through provision of comprehensive information about LARC and contraceptive decision support, providing opportunities to obtain advice from trusted peer educators 69 and health professionals in tandem. However, introducing male partners in contraceptive choices requires careful navigation and further research, with a recent study cautioning the promotion of increased engagement of men in family-planning decisions.…”

“…Enhancing autonomous contraception decision‐making in developing contexts may be achieved through the availability of dedicated family planning counselors in both hospital and community settings to enhance postpartum and post‐abortion care. These settings provide safe and acceptable opportunities to improve IPP LARC access and prevent RRP 75,76 . Community‐based programs may address knowledge gaps through provision of comprehensive information about LARC and contraceptive decision support, providing opportunities to obtain advice from trusted peer educators 69 and health professionals in tandem.…”