The Impact of Demand Factors, Quality of Care and Access to Facilities on Contraceptive Use in Tanzania

Arends‐Kuenning, Mary; Kessy, Flora

doi:10.1017/s0021932005001045

Cited by 41 publications

(35 citation statements)

References 19 publications

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“…Only one previous multi-level study has been conducted in sub-Saharan Africa. This prior study, conducted in Tanzania, also found an association between the information provided to clients and current contraceptive use [15]. However, this earlier study measured information by the availability of educational and promotional material, rather than discussion of side effects, method selection, or proper method use, making comparisons between the two studies problematic.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies conducted in Peru, Egypt, and Morocco in the late 1980s and early 1990s found little to no effect of quality on method use or continuation [12–14]. Conversely, studies conducted between 1991 and 2003 in Tanzania, Egypt, the Philippines, and Nepal found moderate to strong associations between service quality and use [15–18]. Possible explanations for conflicting results among existing multi-level studies include variations in the way that quality is defined and measured.…”

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confidence: 99%

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Quality of Care and Contraceptive Use in Urban Kenya

Tumlinson¹,

Pence²,

Curtis³

et al. 2015

International Perspectives on Sexual and Reproductive Health

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CONTEXT Family planning is highly beneficial to women’s overall health, morbidity, and mortality, particularly in developing countries. Yet, in much of sub-Saharan Africa, contraceptive prevalence remains low while unmet need for family planning remains high. It has been frequently hypothesized that the poor quality of family planning service provision in many low-income settings acts as a barrier to optimal rates of contraceptive use but this association has not been rigorously tested. METHODS Using data collected from 3,990 women in 2010, this study investigates the association between family planning service quality and current modern contraceptive use in five cities in Kenya. In addition to individual-level data, audits of select facilities and service provider interviews were conducted in 260 facilities. Within 126 higher-volume clinics, exit interviews were conducted with family planning clients. Individual and facility-level data are linked based on the source of the woman’s current method or other health service. Adjusted prevalence ratios are estimated using binomial regression and we account for clustering of observations within facilities using robust standard errors. RESULTS Solicitation of client preferences, assistance with method selection, provision of information by providers on side effects, and provider treatment of clients were all associated with a significantly increased likelihood of current modern contraceptive use and effects were often stronger among younger and less educated women. CONCLUSION Efforts to strengthen contraceptive security and improve the content of contraceptive counseling and treatment of clients by providers have the potential to significantly increase contraceptive use in urban Kenya.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Quality of Care and Contraceptive Use in Urban Kenya

Tumlinson¹,

Pence²,

Curtis³

et al. 2015

International Perspectives on Sexual and Reproductive Health

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show abstract

“…However, there has been an increase in the number of babies born outside registered marriages and an increase in the number of people living in de facto relationships. Previous research suggests that childlessness is influenced by marital status [41-43] with the unmarried more likely to remain childless. Marital status may influence a woman's health and wellbeing however due to the small sample size it was not possible to test for associations between marital status and physical and mental health and wellbeing.…”

Section: Discussionmentioning

confidence: 99%

An examination of the health and wellbeing of childless women: A cross-sectional exploratory study in Victoria, Australia

et al. 2011

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BackgroundChildlessness among Australian women is increasing. Despite this, little is known about the physical and mental health and wellbeing of childless women, particularly during the reproductive years. The aims of this exploratory study were to: 1) describe the physical and mental health and wellbeing and lifestyle behaviours of childless women who are currently within the latter part of their reproductive years (30 - 45 years of age); and 2) compare the physical and mental health and wellbeing and lifestyle behaviours of these childless women to Australian population norms.MethodsA convenience sample of 50 women aged between 30 and 45 years were recruited to participate in a computer assisted telephone interview. The SF-36 Health Survey v2 and lifestyle indicators were collected in regards to women's health and wellbeing. Data were analysed using descriptive statistics, t-tests for independent sample means and 95% confidence intervals for the difference between two independent proportions.ResultsChildless women in this study reported statistically significant poorer general health, vitality, social functioning and mental health when compared to the adult female population of Australia. With the exception of vegetable consumption, lifestyle behaviours were similar for the childless sample compared to the adult female population in Australia.ConclusionsChildless women may be at a greater risk of experiencing poor physical and mental health when compared to the Australian population. A woman's health and wellbeing during her reproductive years may have longer term health consequences and as such the health and wellbeing of childless women requires further investigation to identify and address implications for the provision of health (and other social) services for this growing population group.

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“…ensuring continued engagement with services) [12–19]. Providing decision makers in developing countries, including in Africa, with the best available evidence on the factors that determine the quality of care in family planning services, from the perspective of clients and health care providers, is important to inform the design and implementation of the most effective, efficient and acceptable measures.…”

Section: Introductionmentioning

confidence: 99%

Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence

et al. 2016

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BackgroundImproving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa.MethodsQuantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings.ResultsFrom 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client’s waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as ‘pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers’ behaviour.ConclusionThere is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.

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The Impact of Demand Factors, Quality of Care and Access to Facilities on Contraceptive Use in Tanzania

Cited by 41 publications

References 19 publications

Quality of Care and Contraceptive Use in Urban Kenya

Quality of Care and Contraceptive Use in Urban Kenya

An examination of the health and wellbeing of childless women: A cross-sectional exploratory study in Victoria, Australia

Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence

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