Citation
Feeser, Karla; Chakraborty, Nirali M.; Calhoun, Lisa M.; & Speizer, Ilene S. (2020). Measures of Family Planning Service Quality Associated with Contraceptive Discontinuation: An Analysis of Measurement, Learning & Evaluation (MLE) Project Data from Urban Kenya. Gates Open Research, 3, 1453. PMCID: PMC7042708Abstract
Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined - the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ.Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities.
Results: A woman's likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05).
Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.
URL
http://dx.doi.org/10.12688/gatesopenres.12974.2Reference Type
Journal ArticleYear Published
2020Journal Title
Gates Open ResearchAuthor(s)
Feeser, KarlaChakraborty, Nirali M.
Calhoun, Lisa M.
Speizer, Ilene S.
Article Type
RegularPMCID
PMC7042708Data Set/Study
Measurement, Learning & Evaluation (MLE) ProjectContinent/Country
KenyaSex/Gender
WomenORCiD
Speizer - 0000-0001-6204-1316Calhoun - 000-0002-3499-9372