Abstract
BackgroundPerson-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs).MethodsIn this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake.ResultsComparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.ConclusionsMore research is needed on how to intervene to change behaviors related to person-centered family planning.Trial registrationThis study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).
Highlights
Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes
Ensuring that women are supported in making informed choices about family planning methods and are treated in a respectful, autonomous and communicative manner, is essential in all settings, including in India, which has a history of coercive family planning programs [1]
As part of a larger project on person-centered care for family planning, delivery and abortion, we developed and validated a scale to measure person-centered family planning (PCFP) in India, described in more detail elsewhere [17]
Summary
Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). Across India, reproductive healthcare services such as access to family planning and facilitybased delivery services are provided free of charge by the National government to facilitate efforts to improve maternal and neonatal health outcomes [3]. Despite these efforts, 20% of women in India have an unmet need for family planning, which can be linked to high rates of maternal mortality and incidence of unsafe abortions [4, 5]. Even with substantial financial investments put forth by the government, the annual increase of modern family planning use between 2012 and 2018 among reproductive aged women in India has only been 0.1% [6]
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