The impact of the quality of family planning services on safe and effective contraceptive use: A systematic literature review

Abstract

The aim of this review is to identify the features of family planning service provision that are influential in ensuring safe and appropriate contraceptive use and optimal effectiveness of user-dependent methods. A systematic search was carried out of the published and unpublished studies available up to December 1997 that examined the relationship between family planning service provision and contraceptive use. Articles that reported primary data on long-term outcomes were scored by at least two of the authors of the present study. Particular attention was paid to evaluating methods of measuring quality of care. A total of 142 articles were identified, but only 16 reported primary data relating to long-term outcomes. The quality of provider--client exchanges was found to have a net incremental effect on contraceptive use. Evidence of effectiveness of methods to improve uptake, continuation of method use, and safe and appropriate use of fertility control is scant. The evidence that is available indicates that training in communication with clients (particularly about side-effects of contraceptive methods) and an emphasis on client choice are key components of effective interventions. The tasks of listening to clients, and tailoring services to local needs, are crucial to the success of family planning service provision.

Evidence-based clinical guidelines for immigrants and refugees

“…We retained four reviews, two guidelines and six primary studies as the basis for our evidence. 64,[609][610][611][612][613][614][615][616][617][618][619] In our search to update the reference systematic reviews, we found 203 new studies. Our evidence comes from studies in both general and high-risk populations of sexually active women from developed, low-income and middle-income countries.…”

“…Spotting and bleeding associated with some methods are problems for women who have religious and cultural restrictions on intercourse or other activities related to bleeding. 610 In many African and Latin American populations, condom use has connotations of infidelity, promiscuity, extramarital relationships or sexually transmitted infection. Although used by only 1%-2% of North American women aged 15-44 years, the intrauterine device is the most commonly used and most effective reversible contraceptive method worldwide.…”

“…[609][610][611]623 Provider pressure to adopt a method has been shown to be associated with method discontinuation. A randomized trial demonstrated better knowledge improvement when a simpler rather than more detailed chart of contraceptive effectiveness was used.…”

“…636 Unnecessary medical barriers, such as examinations, blood tests and Papanicolaou smears, and a lack of culturally appropriate teaching aids are additional obstacles to contraceptive use. 610 The Interim Federal Health Program covers the cost of contraceptives for Convention refugees, refugee claimants and protected people. Newcomers without health insurance can be guided to publicly funded sexual health clinics that provide services and low-cost contraceptives, regardless of health insurance status.…”

Quality of the contraceptive service structure: A pilot study in Finnish health centre organisations

“…On the other hand, the perspective on quality may be that of health care professionals, an organisation, a client or a sponsor 5 . After the release of Judith Bruce's framework 6 , the quality has often been assessed from a client's standpoint in the field of contraceptive services and the importance of high-quality client-provider interaction has been recognised 7 . For example, the outcome of perceived good quality in contraceptive care has been shown to be associated with improved consistency in contraceptive use 8,9 .…”