Abstract
Use of long-acting reversible contraceptives (LARCs) has grown rapidly in the Democratic Republic of the Congo (DRC), Tanzania, and Uganda. Uptake of LARCs is particularly high during mobile outreach and special family planning day events. It is therefore important to examine client perceptions of and experiences with full, free, and informed choice (FFIC) in different service delivery modalities. Between April and July 2015, we conducted a cross-sectional family planning client survey to assess FFIC and client satisfaction at static, mobile outreach, and special family planning day services in the DRC (n=9 sites), Tanzania (n=13), and Uganda (n=8). The study investigated clients' perceptions across 13 elements of FFIC, including measures of the quality of counseling and respondent satisfaction with services across the service delivery approaches. Composite FFIC scores were constructed and analyzed as the proportion of women who reported affirmatively to all elements and the mean score of positive responses. Satisfaction was assessed using a 4-point Likert scale. We used logistic regression to assess the association between the primary outcomes and mode of service delivery. In total, we interviewed 585 women (n=150 in Uganda, n=200 in Tanzania, and n=235 in the DRC). The large majority of clients in all countries and modalities received their method of choice. Clients of mobile outreach and special family planning days preferred LARCs and permanent methods, particularly implants, compared with clients at static services. Composite measures of FFIC were lower for mobile outreach than for static services in Tanzania among all family planning clients (odds ratio [OR]=0.5; P≤.001) and among LARC clients specifically (OR=0.5; P≤.01); no significant differences were found in the DRC or Uganda. A mean FFIC score among all family planning clients showed that clients in all modalities in all countries reported experiencing most elements of FFIC, with averages ranging from 4.8 to 6.1 of 7 elements. Among LARC clients specifically, mean scores ranged from 8.3 to 9.8 of 11 elements. Where greater proportions of clients experienced higher FFIC, greater proportions of clients also tended to report being "very satisfied" with aspects of services and counseling. The results underscore that special family planning days and mobile outreach services are important and viable ways to increase women's access to family planning services, notably to LARCs, but further attention to respecting and fulfilling clients' full, free, and informed choice across all service delivery modalities is required.
Highlights
Use of long-acting reversible contraceptives (LARCs) has grown rapidly in the Democratic Republic of the Congo (DRC), Tanzania, and Uganda
Data were collected from 150 respondents in Uganda (90 static; 60 mobile outreach); 200 respondents in Tanzania (100 static; 100 mobile outreach); and 235 respondents in the DRC (55 static; 120 mobile outreach; 60 special family planning days)
Women at mobile outreach and special family planning days were less literate compared with women at static services (60.8%, P.01, and 63.3%, P.05, respectively, compared with 83.3%), and less likely to own a mobile phone (46.7%, P.001, and 56.7%, P.05, respectively, compared with 74.6%) (Table 2)
Summary
Use of long-acting reversible contraceptives (LARCs) has grown rapidly in the Democratic Republic of the Congo (DRC), Tanzania, and Uganda. In many sub-Saharan African countries, service delivery modalities such as mobile outreach services and special family planning days play an important role in increasing the use of modern contraception, especially underutilized, long-acting reversible contraceptives (LARCs) and permanent methods.[1,2,3,4,5,6,7]. Mobile outreach services are crucial for increasing equitable access By design, they serve poorer, marginalized, and geographically hardto-reach communities and populations.[4,7,8,9] Such services are characterized by the deployment of trained providers to lower-level health facilities or temporary set-ups—such as tents or community spaces—that are equipped with the required contraceptives and supplies.[6,7,9,10]. Trained providers and counselors assemble in sufficient numbers to dedicate themselves to family planning for the day and plan to have sufficient stock on hand, thereby creating confidence in the community and among clients that family planning methods will be available
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