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      Assessment of Family Planning Counseling Provided for Postpartum Women and Associated Factors

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      1 , , 2
      International Journal of Reproductive Medicine
      Hindawi

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          Abstract

          Background

          Good quality family planning counseling particularly in the postpartum period is paramount to contraception adoption and continuation; it is also paramount in the reduction of maternal as well as infant morbidity and mortality.

          Objective

          Assess the level of family planning counseling provided for women in their immediate postpartum period in the labor ward at Saint Paul's Hospital in 2019.

          Method

          An institution-based cross-sectional study was conducted from February to March of 2019 among women in the labor ward. A face-to-face exit interview was conducted with 209 randomly selected women. A structured pretested questionnaire was used to assess the level of family planning counseling provided. Bivariate logistic regression was used to test for statistical association.

          Results

          Only 28.2% of the counseling sessions were adequate. Most (58.9%) of the counseling sessions did not maintain the privacy of the client. In 67.9% of the sessions, the counselor did not ask the concern of the client regarding the use of modern family planning methods and 74.2% of the clients were not told about the possible side effects of a method. Clients with no formal education (OR = 2.52, 95%CI = 1.1‐3.3) and those with only primary level education (OR = 1.22, 95%CI = 1.04‐3.02) were more likely to have had inadequate counseling.

          Conclusion

          The level of family planning counseling was inadequate. The study indicated the need to provide training for service providers on family planning counseling with the existing standard frameworks but also in consideration of the sociodemographic background of the client, particularly their educational status.

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          Most cited references13

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          Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda

          Abstract The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility data from Burkina Faso, Ethiopia, Kenya and Uganda and (2) examine the influence of structural quality on contraceptive practice in these four countries. We used nationally representative cross-sectional survey data of health facilities and women of reproductive age. First, we constructed quality scores for facilities using principal component analysis to integrate 18 variables. Second, we linked women to their closest facility using geo-coordinates. Third, we estimated multivariable logistic regression models to calculate women’s odds ratios for modern contraceptive use adjusting for facilities’ quality and other factors. In Burkina Faso, Ethiopia and Uganda, the odds of using a modern method of contraception was greater if the nearest facility provided high- or medium-quality services compared with low quality in the univariable model. After controlling for possible confounders, the adjusted odds ratios were significant for high quality (aOR: 3.12, P value: 0.005) and medium quality (aOR: 2.57, P value: 0.009) in Ethiopia and in the hypothesized direction but not statistically significant in Uganda or Burkina Faso, and in the opposite direction in Kenya. A process quality measure—having been visited by a community health worker—was statistically significantly associated with modern contraceptive use in three of the four countries (Burkina Faso aOR: 2.18, P value: 0.000; Ethiopia aOR: 1.78, P value: 0.000; Uganda aOR: 1.96, P value: 0.012). These results suggest that service quality in public facilities may be less relevant to contraceptive use in environments where the universe and reach of providers changes actively. Programs promoting contraception therefore need to consider quality within facility types and their service environments.
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            Counseling on family planning during ANC service increases the likelihood of postpartum family planning use in Bahir Dar City Administration, Northwest Ethiopia: a prospective follow up study

            Background Closely spaced pregnancies within the first year postpartum increases the risk of death for both the mother and baby. Many countries recommend providing pregnant women with post-partum family planning counselling during antenatal care visits. However, data on the extent to which providers utilize these opportunities and the role of family planning counseling during antenatal care in promoting the use of postpartum modern family planning remain limited especially in developing countries. Therefore, this study was aimed at investigating the role of family planning counseling during antenatal care in promoting postpartum modern family planning use within 6 weeks after birth. Methods Nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first Antenatal Care (ANC) visit were enrolled and followed until 6 weeks after delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist to assess whether or not the providers counsel pregnant women on post-partum family planning use during their four focused ANC visits. Exit interview was also conducted at 6 weeks after they gave birth when they came to immunize their child to assess whether they were starting to use postpartum modern family planning. Completed data were obtained from 823 women. Generalized Estimating Equation was carried out to identify predictors of postpartum modern family planning use by controlling the cluster effect among women who received ANC services in the same health facility. Results Postpartum modern family planning use within 6 weeks after delivery among the study women was 157(19.1%) with 95%CI (16.4, 21.9); Among 187 pregnant women who were counseled at least once, 72(38.5%) of them used post-partum modern family planning compared to 13.4% of post-partum women who were not counseled at all (p < 0.001). Counseling about postpartum family planning during antenatal care, satisfaction on the antenatal care services women received while they were pregnant, counseling on birth preparedness and complication readiness plan, counseling on breast feeding and post-natal care use were independent predictors for postpartum modern family planning use. Conclusion Less than one in five post-partum women were using postpartum family planning within 6 weeks after birth. Family planning counseling during ANC services had a significant effect on promoting postpartum modern family planning use. Therefore, health providers need to ensure continuity of care through strengthening integration of family planning counseling services during ANC and referral linkages between community and health workers.
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              Quality of care in family planning services in Senegal and their outcomes

              Background High quality of care in family planning (FP) services has been found to be associated with increased and continued use of contraceptive methods. The interpersonal skills and technical competence of the provider is one of the main components of quality of care. To study the process component of quality of care, the distribution of the FP counseling topics was examined by client, provider and facility characteristics. To assess the outcomes of quality of care, client satisfaction and their knowledge of their method’s protection from STIs were used. This study examined the factors associated with these outcomes with a focus on provider counseling and training. Methods Data from the 2012–2013 Senegal Service Provision Assessment survey was used for the analysis. The survey included a representative sample of the health facilities in Senegal and collects data by observing the clients’ FP visits and conducting exit interviews. The main outcomes of interest were provider’s counseling in FP, client’s satisfaction with FP services and client’s knowledge of their method’s protection from STIs. Several covariates were used in the analysis which represent client, provider and facility characteristics. Results The level of counseling was inadequate-- very low proportions of providers that performed different types of counseling. Counseling was more likely to be provided to new than returning clients. Approximately 84% of the clients were very satisfied with services but only 58% had correct knowledge of their method’s protection from STIs. Clients were significantly less likely to be very satisfied when their providers counseled on side effects and when to return, and counseling provided on method’s protection from STIs did not significantly improve knowledge in this area. Clients seen by a provider with FP training had almost twice the odds of having correct knowledge about their method’s protection from STIs compared with clients seen by a provider with no recent training. Conclusions The percentage of providers offering FP counseling to their clients was relatively low and was ineffective on the client-focused outcomes. Interventions may be required for more effective counseling methods that are client-centered as well as providing more FP training to providers.
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                Author and article information

                Contributors
                Journal
                Int J Reprod Med
                Int J Reprod Med
                IJRMED
                International Journal of Reproductive Medicine
                Hindawi
                2356-7104
                2314-5757
                2020
                25 January 2020
                : 2020
                : 2649340
                Affiliations
                1Department of Medicine, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
                2Epidemiology Unit, Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
                Author notes

                Academic Editor: Robert Gaspar

                Author information
                https://orcid.org/0000-0001-7589-5898
                Article
                10.1155/2020/2649340
                7007746
                32047803
                86168b8b-a1fc-4793-870a-29c22bdfad15
                Copyright © 2020 Munit Abdulreshid and Hailemichael B. Dadi.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 August 2019
                : 26 October 2019
                : 14 January 2020
                Funding
                Funded by: Saint Paul's Hospital Millennium Medical College
                Categories
                Research Article

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