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

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

Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4)

“…Our findings suggest that women who were told about other methods of contraceptives, who were told about the side effects of contraceptives, and who were informed about what to do in case they experienced any side effects were more likely to use IUDs. These findings correspond with prior smaller-scale research from India ( Dey, Averbach, et al, 2021 ) and demonstrate that improving the quality of counseling provided to women may play an important role in increasing the uptake of IUDs as a contraceptive option.…”

Contraception for married adolescents (15–19 years) in India: insights from the National Family Health Survey-4 (NFHS-4)

“…Better quality of FP services is considered key to meeting the demand for FP and maximizing client satisfaction [ 7 , 8 ]. Though the quality of FP services is associated with a higher uptake of contraceptives [ 9 ], small scale studies from India reveal that quality of FP services is low in the country [ 10 , 11 ].…”

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

“…2019; Dey et al. 2021), yet women may choose to stop using contraception for a variety of reasons that still align with their reproductive goals and preferences. We posited that women's reflections on their counseling experiences, months after their initial visit, and their care‐seeking practices related to the management of side effects would offer better insights into the impact of higher quality contraceptive counseling than programmatic measures.…”