Planning Service Use Research Articles

"You could find a good or a bad provider, I would say you just have to go and see": A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso.

This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women's motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15-19 and 20-24 and ever married women ages 15-24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women's demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women's (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence.

Assessment of Family planning services utilization among women of Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir

Objectives: To determine the percentage of women in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir who use family planning services, and to determine the relationship between demographic characteristics and family planning service use (AJ&K). Study design and setting: A cross-sectional study was conducted in UC Bangoin (Rawalakot) Azad Jammu and Kashmir over the duration of 6 months, from 5 January to 5 July 2021. Methodology: A sample of 344 married women with the age range 18 to 45 was obtained. The study's assessment instrument was developed from an existing assessment tool (Reproductive health knowledge and services utilization among rural adolescence in Ethiopia 2014). It included 14 questions on demographics and 13 questions about the use of family planning services. Results: High utilization was 52% (n=179) while low utilization was 48% (n=165). Most of them had fear of side effects of using contraception (n=170, 48.9%). Chi-square test showed significant association (p-val =0.05) between fear of side effects of using contraception, decision of using contraception, education level, distance from home to hospital, number of children, exposure to mass media and utilization of family planning services. Conclusion: There was low family planning services utilization in that area. Study showed that there was a strong association between fear of side effects of using contraception, low education and low exposure to mass media with utilization of family planning services in Union Council Bangoin (Rawalakot) Azad Jammu and Kashmir (AJ&K)

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey.

Depression is a heterogeneous disorder with multiple aetiological pathways and multiple therapeutic targets. This study aims to determine whether atypical depression (AD) characterized by reversed neurovegetative symptoms is associated with a more pernicious course and a different sociodemographic, lifestyle, and comorbidity profile than nonatypical depression (nonAD). Among 157 366 adults who completed the UK Biobank Mental Health Questionnaire (MHQ), N = 37 434 (24%) met the DSM-5 criteria for probable lifetime major depressive disorder (MDD) based on the Composite International Diagnostic Interview Short Form. Participants reporting both hypersomnia and weight gain were classified as AD cases (N = 2305), and the others as nonAD cases (N = 35 129). Logistic regression analyses were conducted to examine differences between AD and nonAD in depression features, sociodemographic and lifestyle factors, lifetime adversities, psychiatric and physical comorbidities. Persons with AD experienced an earlier age of depression onset, longer, more severe and recurrent episodes, and higher help-seeking rates than nonAD persons. AD was associated with female gender, unhealthy behaviours (smoking, social isolation, low physical activity), more lifetime deprivation and adversity, higher rates of comorbid psychiatric disorders, obesity, cardiovascular disease (CVD), and metabolic syndrome. Sensitivity analyses comparing AD persons with those having typical neurovegetative symptoms (hyposomnia and weight loss) revealed similar results. These findings highlight the clinical and public health significance of AD as a chronic form of depression, associated with high comorbidity and lifetime adversity. Our findings have implications for predicting depression course and comorbidities, guiding research on aetiological mechanisms, planning service use and informing therapeutic approaches.

Reproductive autonomy and family planning service use among young women in Ghana

Objectives: Reproductive autonomy has been associated with contraceptive use among U.S. and Ghanaian women. To understand whether reproductive autonomy might affect a young woman’s ability to navigate the health system, we examined the association between reproductive autonomy and family planning service use among young women in Ghana.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana.

ObjectiveUsing our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana.MethodsWe drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models.ResultsIn unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55).ConclusionsFindings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.

Quasi-experimental Study of Systematic Screening for Family Planning Services among Postpartum Women Attending Village Health and Nutrition Days in Jharkhand, India.

Background:Systematic screening helps increase family planning uptake through integration with other services, including immunization. Though successfully demonstrated at health facilities, this strategy has not been demonstrated in communities. This study assessed the effectiveness of systematic screening to increase postpartum family planning use during community health days in India without adversely affecting immunization services.Methods:The study was conducted during 180 individual Village Health and Nutrition Days in Jharkhand, India. All health workers were trained in postpartum family planning counseling. Intervention providers were also trained in systematic screening. 217 postpartum women aged 15–49 years participated in baseline and endline exit interviews and routine service statistics were analyzed from 2,485 facility visits at affiliated health centers.ResultsNo difference in family planning service use was found in the intervention group, but significantly fewer interviewed women reported receiving family planning services at endline in the comparison group (p = 0.014). Family planning acceptance at affiliated health centers increased significantly in intervention areas (p < 0.001) but not in comparison areas, while immunization service use increased in both groups (p = 0.002 intervention, p < 0.001 comparison).Conclusions:The use of the postpartum systematic screening tool appears to increase acceptance of family planning services when integrated with community-based services in Jharkhand.

Social and demographic disparities in preventive family planning service use among adult women in the United States

To examine factors associated with adult women’s use of preventive family planning services, 2006–2010.

Discouraging trends in reproductive health service use among adolescent and young adult women in the USA, 2002-2008.

To investigate reproductive health service use by young women in the USA between 2002 and 2008. Using data from two waves of The National Survey of Family Growth, we investigated reproductive health service utilization among women aged 15-24 years (2002 n=2157; 2006-2008 n=2264). Descriptive and univariate statistics and multivariate regression models were employed to describe types of reproductive health services used and compare service use across years. Analyses focused on questions regarding specific recent use of reproductive health services (within the previous 12 months). Over half the pooled sample (n=4421) reported lifetime family planning clinic (58%) and recent reproductive health service (59%) use, including contraceptive (48%), gynecological exam (47%) and counseling (37%) services. Lifetime family planning service use declined by 15% from 2002 to 2008 (P<0.001) and recent reproductive health service use by 8% (P=0.01), including gynecological exam (8%, P= 0.03) and contraceptive (6%, P= 0.02) services. By 2006-2008, women were less likely to use reproductive health and contraceptive services than in 2002 [odds ratio (OR) 0.6, confidence interval (CI) 0.5, 0.8, P< 0.001 and OR 0.7, CI 0.6, 0.9, P= 0.005, respectively]. Trends were similar but smaller in magnitude among the sexually experienced women, with a 5% decline in both reproductive health (OR 0.7, CI 0.6, 1.0, P= 0.02) and contraceptive (OR 0.8, CI 0.6, 1.0, P= 0.03) service use. Reproductive health service use among young women in the USA has declined over the past decade. Public health and policy strategies are needed to promote service use, ultimately to improve reproductive health outcomes.

Case Study: Does training of private networks of Family Planning clinicians in urban Pakistan affect service utilization?

BackgroundTo determine whether training of providers participating in franchise clinic networks is associated with increased Family Planning service use among low-income urban families in Pakistan.MethodsThe study uses 2001 survey data consisting of interviews with 1113 clinical and non-clinical providers working in public and private hospitals/clinics. Data analysis excludes non-clinical providers reducing sample size to 822. Variables for the analysis are divided into client volume, and training in family planning. Regression models are used to compute the association between training and service use in franchise versus private non-franchise clinics.ResultsIn franchise clinic networks, staff are 6.5 times more likely to receive family planning training (P = 0.00) relative to private non-franchises. Service use was significantly associated with training (P = 0.00), franchise affiliation (P = 0.01), providers' years of family planning experience (P = 0.02) and the number of trained staff working at government owned clinics (P = 0.00). In this setting, nurses are significantly less likely to receive training compared to doctors (P = 0.00).ConclusionsThese findings suggest that franchises recruit and train various cadres of health workers and training maybe associated with increased service use through improvement in quality of services.

Barriers to family planning service use among the urban poor in Pakistan

Although fertility has shown some decline in Pakistan in recent years, contraceptive use remains low. Despite high knowledge of modern methods of contraception (94 per cent of married women know of a modern method of contraception) only 17 per cent of married women of reproductive age currently use a modern method of contraception (Pakistan Reproductive Health and Family Planning Survey, 2001; Sathar and Casterline, 1998). This is in part a product of poor physical access to family planning services. The coverage and quality of family planning services is poor, with only 10 per cent of the population living within easy walking distance of government-operated family planning services (Rosen and Conly, 1996). Consequently, there exists a large unmet need for family planning services in Pakistan (Mahmood and Ringheim, 1997). Previous research, however, into the barriers to family planning service use has highlighted the importance of looking beyond physical access to examine barriers that arise from the socio-economic and cultural environment in which an individual lives (Bertrand and others, 1995; Foreit and others, 1978). Pakistan presents an interesting context for examining the range of potential barriers to the use of family planning services, with a low level of economic development and strict cultural norms that may inhibit service utilization. This paper identifies the barriers to family planning service use among women in urban slum areas. The paper also examines the characteristics of urban poor women who report different types of barriers to using family planning services. Gaining a better understanding of the types of women who are likely to experience particular barriers to family planning services is valuable for developing service promotion strategies and for informing service delivery protocols.

Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda

Senga (father's sister) is a traditional channel of communication about sexual behaviour for adolescent females in rural Uganda. We evaluated a modification of this approach as an intervention for HIV and STDs in a pilot study in two intervention villages and one control village over 12 months. Eleven adult women and three adolescent girls were chosen and trained to become sengas. Adolescent girls were encouraged to visit the sengas for sexual health information. Adult sengas saw an average of 21 clients; adolescent sengas saw five. Adolescent girls made 45% of visits. The expected reasons for attending the sengas accounted for 51% of visits. Knowledge about HIV/AIDS, sexual communication skills, consistent condom use and family planning service use increased in the intervention group of girls over the study period and compared to control girls. Symptomatic STDs decreased in the intervention group. This intervention was readily accepted by the community; members of all ages and both sexes attended for a wider variety of reasons than anticipated. Adolescent girls in the intervention group showed improved knowledge, attitudes and practices related to HIV and STDs. This promising intervention warrants further testing in larger studies and other settings.