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

Abstract

Introduction Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage. Methods Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16–44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Results Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49). Conclusion Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits.

Measuring Coverage of Essential Maternal Postnatal Care Services in the Squatter Settlements of Islamabad Capital Territory in Pakistan

“…35 Similar findings were observed in other countries. 36,37 Our study showed 49 percent of women received counseling on all important aspects of the postnatal period, which is similar to other studies. 38,39 The continuum of maternal care pathway that connects three components of care that is, ANC, skilled birth attendants, and PNC is a vital approach for addressing maternal, newborn, and child health challenges.…”

“…35 Similar findings were observed in other countries. 36,37 Our study showed 49 percent of women received counseling on all important aspects of the postnatal period, which is similar to other studies. 38,39…”

Does family planning counselling during health service contact improve postpartum modern contraceptive uptake in Ethiopia? A nationwide cross-sectional study

“…This was supported by previous studies. 16 21 22 This was inconsistent with some previous studies from Ethiopia, which indicated a lack of association between family planning counselling and postpartum modern contraceptive uptake. 23 26 27 One reason for the inconsistency might be due to the differences in the quality of the family planning counselling.…”

“…[13][14][15] Provision of family planning counselling during pregnancy, childbirth and postpartum periods is one of the key strategies to improve postpartum modern contraceptive uptake and space subsequent pregnancies. 16 Furthermore, increasing pregnancy spacing could prevent up to 32% of maternal and 21% of child mortalities. 1 In order to improve postpartum contraceptive uptake in low/middle-income countries, the WHO recommends that women receive family planning counselling integrated within maternal and child health services, such as antenatal care (ANC), childbirth, postnatal care (PNC), and well-baby care, immunisation and growth monitoring.…”

Understanding the global dynamics of continuing unmet need for family planning and unintended pregnancy

“…As well as the quality of family planning counselling, evidence shows that the routine integration of quality FP counselling into the delivery of other health services, such as ANC/PNC visits and HIV testing, can lead to an increased uptake of family planning, and therefore a reduction in unmet need (Amour et al, 2021 ; Dev et al, 2019 ). However, integration needs to be done in such a way as to ensure the quality of the family planning counselling is maintained.…”