Abstract
Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015-16 and District Level Household and Facility Survey (DLHS) 2012-13. The study is limited to only districts whose data are available in both DLHS 2012-13 and NFHS 2015-16. The methods of analysis include bivariate statistics, Pearson's chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client's confidence in the services, which is the key to success for any voluntary family planning program like in India.
Highlights
Quality of care (QoC) in family planning services is recognized as a key to improving the health of women and children and as a human right [1]
Since we hypothesized that the clients within the same district might get the chance of a similar QoC in sterilization services compared to those clients from other districts, the analysis involving only one level of data violates the assumptions of equal variance and independence of observations
Out of 145,301 clients selected for the study, 27% lived in urban areas, and 73% lived in rural areas (Table 1)
Summary
Quality of care (QoC) in family planning services is recognized as a key to improving the health of women and children and as a human right [1]. A set of background characteristics of the women was considered in this analysis These variables were found to be associated with the receipt of the QoC for sterilization services in earlier studies [27,28,29,30,31]. The odds of receiving low-quality care in sterilization services among the poorest is 5.6 times (AOR: 5.609 [5.140–6.120]) higher than that of the richest groups. The women of the poorer, middle, and richer quintiles have 3.39 times (AOR: 3.392 [3.124– 3.682]) 2.4 times (AOR: 2.409 [2.226–2.608]) and 1.68 times (AOR: 1.678 [1.551–1.815]) higher odds of receiving low-quality sterilization care than richest counterparts. The results of the structure scores show that the health facilities with low Infrastructure have 1.20 times (AOR: 1.196 [1.074–1.332]) higher odds of providing low-quality sterilization services
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