Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews.

Susan Ontiri,Mark Kabue,Jelle Stekelenburg,Peter Gichangi,Regien Biesma,Philip Anglewicz

doi:10.1371/journal.pone.0256295

Abstract

BackgroundAvailable evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya.MethodsWe conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services.ResultsThe Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively.ConclusionThe quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.

Highlights

Addressing unmet need for contraception is a public health and development agenda espoused in several global commitments meant at supporting women to achieve their fertility aspirations
Women aged 15–24 years had lower odds of receiving better counseling compared to women aged 35 years and above
Those with no education, primary and secondary were less likely to receive better counseling compared to those with tertiary education

Summary

Introduction

Addressing unmet need for contraception is a public health and development agenda espoused in several global commitments meant at supporting women to achieve their fertility aspirations. An analysis of demographic health survey (DHS) data from 34 developing countries found out that past contraceptive users with unmet need for modern methods accounted for 38% of all women with current unmet need [4]. In another DHS analysis from a diverse set of 15 countries, 7–27% of past contraceptive users discontinued due to reasons related to the quality of care they received [5]. Available evidence indicates that integrating quality of care in the provision of FP services at initiation is positively associated with the continuation of contraceptive use [5, 6], which can reduce the unmet need for contraception.

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Conclusion